Skip to main content
SpringerLink
Log in

Allograft Prosthetic Reconstruction in Revision Total Hip Arthroplasty

  • Chapter
  • First Online:
Hip Arthroplasty

  • 192 Accesses

Abstract

Incidence of revision hip arthroplasty is rising substantially worldwide. Wear and instability are the primary causes of hip revision; in developing countries, hip revisions secondary to prosthetic joint infection (PJI) are a growing challenge. Loosening, protrusio, synovitis, instability, poor bone stock, bone defects and high post-operative infection rates are some of the conditions that further complicate a revision hip surgery. Accurate diagnosis of the cause of failure of total hip arthroplasty (THA), preoperative clinical and radiological assessment, evaluation of records, assessment of inter-compatibility of the prosthetic hip components and arrangement of inventory for all per op eventualities are crucial for a successful outcome. Hip revision surgery has high rates of complications and failure mainly due to infection, instability, graft dissolution and implant breakage. Large bone defects, pelvic discontinuity and severe osteolysis due to wear or prosthetic joint infection pose a complex scenario to a revision hip surgeon. Allograft usage in hip revision surgery in such complex hip revisions is unique as it not only provides a means for filling the bone defects and achieving stability but also has a high potential to provide a biological solution to rebuild the bone stock and potentially reduce the morbidity of any future revision surgery, that too at very low costs in comparison with other available expensive prosthetic rebuilding options. Conservative revisions with preservation of soft tissue and bone stock, restoration of leg length, early return to function and reduced morbidity are the primary goals of a revision total hip arthroplasty (rTHA). High satisfaction rates and good clinical outcomes are expected by achieving these goals and reducing complications at the same time. A conservative and biological approach to hip revision is the key to better outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–5. https://doi.org/10.2106/JBJS.F.00222.

    Article  PubMed  Google Scholar 

  2. Park JW, Won SH, Moon SY, Lee YK, Ha YC, Koo KH. Burden and future projection of revision total hip arthroplasty in South Korea. BMC Musculoskelet Disord. 2021;22:375. https://doi.org/10.1186/s12891-021-04235-3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gwam CU, Mistry JB, Mohamed NS, et al. Current epidemiology of revision total hip arthroplasty in the United States: national inpatient sample 2009 to 2013. J Arthroplast. 2017;32(7):2088–92. https://doi.org/10.1016/j.arth.2017.02.046.

    Article  Google Scholar 

  4. Kerzner B, Kunze KN, O'Sullivan MB, Pandher K, Levine BR. An epidemiological analysis of revision aetiologies in total hip arthroplasty at a single high-volume centre. Bone Jt Open. 2021;2(1):16–21. https://doi.org/10.1302/2633-1462.21.BJO-2020-0171.R1. Published 2021 Jan 3

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mittal G, Kulshrestha V, Kumar S, Datta B. Epidemiology of revision total hip arthroplasty: an Indian experience. Indian J Orthop. 2020;54:608–15. https://doi.org/10.1007/s43465-020-00086-7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–37.

    Google Scholar 

  7. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast. 1994;9(1):33–44. https://doi.org/10.1016/0883-5403(94)90135-x.

    Article  CAS  Google Scholar 

  8. Saleh KJ, Holtzman J, Gafni A, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19:50–6.

    Article  CAS  PubMed  Google Scholar 

  9. Gustilo RB, Pasternak HS. Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res. 1988;235:111–9.

    Article  Google Scholar 

  10. Gross AE, Allan DG, Catre M, Garbuz DS, Stockley I. Bone grafts in hip replacement surgery. The pelvic side. Orthop Clin North Am. 1993;24:679–95.

    Article  CAS  PubMed  Google Scholar 

  11. Parry MC, Whitehouse MR, Mehendale SA, et al. A comparison of the validity and reliability of established bone stock loss classification systems and the proposal of a novel classification system. Hip Int. 2010;20:50–5.

    Article  PubMed  Google Scholar 

  12. Pulido L, Rachala SR, Cabanela ME. Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants. Int Orthop. 2011;35(2):289–98.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hungerford DS, Jones LC. The rationale of cementless revision of cemented arthroplasty failures. Clin Orthop. 1988;235:13.

    Article  Google Scholar 

  14. Engh CA, Glassman AH, Griffin WL, Mayer JG. Results of cementless revision for failed cemented total hip arthroplasty. Clin Orthop. 1988;235:92.

    Article  Google Scholar 

  15. Buttaro MA, Comba F, Pusso R, Piccaluga F. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res. 2008;466:2482–90.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Slooff TJ, Buma P, Schreurs BW, Schimmel JW, Huiskes R, Gardeniers J. Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop Relat Res. 1996;324:108–15.

    Article  Google Scholar 

  17. Trumm BN, Callaghan JJ, George CA, Liu SS, Goetz DD, Johnston RC. Minimum 20-year follow-up results of revision total hip arthroplasty with improved cementing technique. J Arthroplast. 2014;29:236–41.

    Article  Google Scholar 

  18. Highcock A, Siney P, Wroblewski BM, Wynne JH, Raut VV. Severe femoral osteolysis treated with a cemented Charnley revision arthroplasty. Clinical and radiological follow-up to 27 years. Orth Proc. 2015;97-B:51.

    Google Scholar 

  19. Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg. 1980;62A:1059.

    Article  Google Scholar 

  20. Lachiewicz PF, McCaskill B, Lnglis A, et al. Total hip arthroplasty in juvenile rheumatoid arthritis: two-to-eleven-year results. J Bone Joint Surg. 1986;64A:502.

    Article  Google Scholar 

  21. Piriou P, Norton M, Marmorat JL, Judet T. Acetabular reconstruction in revision hip surgery using femoral head block allograft. Orthopaedics. 2005;28(12):1437–44.

    Article  Google Scholar 

  22. Jasty M, Harris WH. Total hip reconstruction using frozen femoral head allografts in patients with acetabular bone loss. Orthop Clin North Am. 1987;18:291.

    Article  CAS  PubMed  Google Scholar 

  23. Lamo-Espinosa J, Duart Clemente J, Díaz-Rada P, Pons-Vil-lanueva J, Valentí-Nín JR. The Burch–Schneider anti- protrusio cage: medium follow-up results. Musculoskeletal Surg. 2013;97(1):31–7.

    Article  CAS  Google Scholar 

  24. Hourscht C, Abdelnasser MK, Ahmad SS, Kraler L, Keel MJ, Siebenrock KA, Klenke FM. Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: high failure in pelvic discontinuity. Arch Orthop Trauma Surg. 2017;137(8):1139–48.

    Article  PubMed  Google Scholar 

  25. Berry DJ, Müller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;74:711–5.

    Article  CAS  PubMed  Google Scholar 

  26. Traina F, Giardina F, De Clerico M, Toni A. Structural allograft and primary press-fit cup for severe acetabular deficiency. A minimum 6-year follow-up study. Int Orthop. 2005;29(3):135–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Sporer SM, O’Rourke M, Chong P, Paprosky WG. The use of structural distal femoral allografts for acetabular reconstruction. Average ten-year follow-up. J Bone Joint Surg Am. 2005;87:760–5.

    Article  PubMed  Google Scholar 

  28. Leopold SS, Jacobs JJ, Rosenberg AG. Cancellous allograft in revision total hip arthroplasty. A clinical review. Clin Orthop Relat Res. 2000;371:86–97.

    Article  Google Scholar 

  29. Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty. Acetabular technique. Clin Orthop Relat Res. 1994;298:147–55.

    Article  Google Scholar 

  30. Della Valle CJ, Paprosky WG. Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision THA. J Bone Joint Surg Org. 2003;85-A(Suppl. 4)

    Google Scholar 

  31. Rodgers B, Wernick G, Roman G, Beauchamp GP, Spangehl MJ, Schwartz AJ. A contemporary classification system of femoral bone loss in revision total hip arthroplasty. Arthroplasty Today. 2021;9:134–40. https://doi.org/10.1016/j.artd.2021.04.012.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Khuangsirikul S, Chotanaphuti T. Management of femoral bone loss in revision total hip arthroplasty. J Clin Orthop Trauma. 2020;11:29–32. https://doi.org/10.1016/j.jcot.2019.12.004.

    Article  PubMed  Google Scholar 

  33. Ibrahim DA, Fernando ND. Classifications in brief: the Paprosky classification of femoral bone loss. Clin Orthop Relat Res. 2017;475:917–21. https://doi.org/10.1007/s11999-016-5012-z.

    Article  PubMed  Google Scholar 

  34. de Alencar AGC, Ventura Vieira IF. Bone banks, update article. Rev Bras Orthop. 2010;45(6):524–8. https://doi.org/10.1016/S2255-4971(15)30297-4.

    Article  Google Scholar 

  35. Gaski GE, Scully SP. In brief: classifications in brief: vancouver classification of postoperative periprosthetic femur fractures. Clin Orthop Relat Res. 2011;469(5):1507–10. https://doi.org/10.1007/s11999-010-1532-0.

    Article  PubMed  Google Scholar 

  36. Kinov P, Tivchev P. Chapter 15. Revision hip arthroplasty: management of bone loss. Intech Arthroplasty. 2013; https://doi.org/10.5772/53249.

  37. Neil MJ. Revision hip arthroplasty. Chapter 65: Evaluation and management of femoral bone defects in revision total hip arthroplasty.

    Google Scholar 

  38. Babis GC, Sakellariou VI, O’connor MI, Hanssen AD, Sim FH. Proximal femoral allograft-prosthesis composites in revision hip replacement a 12-year follow-up study. J Bone Joint Surg. 2010;92-B:349–55.

    Article  Google Scholar 

  39. Uchiyama K, Moriya M, Yamamoto T, Fukushima K, Takahira N, Itoman N. Revision total hip arthroplasty using an interlocking stem with an allograft-prosthesis composite. Acta Orthop Belg. 2013;79:398–405.

    PubMed  Google Scholar 

  40. Lee JM, Roh JY, Lee JH, Wang WJ, Kim HM. Fate of morselized impaction allograft used for the defect of acetabulum in revision total hip arthroplasty. J Korean Musculoskeletal Transpl Soc. 2004;4:104–11.

    Google Scholar 

  41. Lee J-M, Kim T. Acetabular cup revision arthroplasty using morselized impaction allograft. Hip Pelvis. 2018;30(2):65.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Oakeshott RD, Morgan DAF, Zukor DJ, et al. Revision total hip arthroplasty with osseous allograft reconstruction: a clinical and roentgenographic analysis. Clin Orthop. 1987;225:37.

    Article  Google Scholar 

  43. Schreurs BW, Luttjeboer J, Thien TM, et al. Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis. A concise follow-up, at eight to nineteen years, of a previous report. J Bone Joint Surg Am. 2009;91:646–51.

    Article  PubMed  Google Scholar 

  44. Dearborn JT, Harris WH. High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg Am. 1999;81(4):469–80.

    Article  CAS  PubMed  Google Scholar 

  45. Pellicci PM, Wilson PD Jr, Sledge CB, et al. Long-term results of revision total hip replacement. A follow-up reports. J Bone Joint Surg Am. 1985;67:513–6.

    Article  CAS  PubMed  Google Scholar 

  46. Roos BD, Roos MV, Júnior AC, Lampert HB, da Silva ML. Circumferential proximal femoral allografts in total hip arthroplasty revision surgery. Rev Bras Orthop. 2012;47(6):754–9.

    Article  Google Scholar 

  47. Rogers BA, Sternheim A, Backstein D, Safir O, Gross AE. Proximal femoral allograft for major segmental femoral bone loss: a systematic literature review. SAGE-Hindawi Access to Research. Adv Orthop. 2011;257572:7 pages. https://doi.org/10.4061/2011/257572.

  48. Wilke BK, Houdek MT, Rose PS, Sim FH. Proximal femoral allograft-prosthetic composites: do they really restore bone? A retrospective review of revision allograft-prosthetic composites. J Arthroplast. 2019;34:346–51. https://doi.org/10.1016/j.arth.2018.10.020.

    Article  Google Scholar 

Download references

Acknowledgement

The authors thank and acknowledge the invaluable contribution by Dr. Kiran Kharat Consultant Orthopaedic Surgeon at Ruby Hall Clinic Pune, for his intricate drawings depicting the complex hip conditions included in the chapter.

Author information

Authors and Affiliations

  1. Department Orthopaedics, Armed Forces Medical College, Pune, Maharashtra, India

    Chetan Sood

  2. JRC, Army Hospital (Research & Referral), New Delhi, India

    Santhosh Kumar

Authors
  1. Chetan Sood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Santhosh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Head of Orthopedics and Joint Replacement, Amrita Institute of Medical Sciences Amrita Vishwavidyapeetham, Faridabad, India

    Mrinal Sharma

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sood, C., Kumar, S. (2023). Allograft Prosthetic Reconstruction in Revision Total Hip Arthroplasty. In: Sharma, M. (eds) Hip Arthroplasty. Springer, Singapore. https://doi.org/10.1007/978-981-99-5517-6_61

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-5517-6_61

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-5516-9

  • Online ISBN: 978-981-99-5517-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation