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Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem.

Questions/purposes

We used a sensitive technique to measure subsidence of a cemented polished collarless double-taper stem at each interface after femoral impaction grafting and compared subsidence, radiographic loosening, complications, and reoperations over three series of hips defined by technique developments.

Patients and Methods

Three series were defined: Series 1 (n = 23, irradiated allograft), Series 2 (n = 12, double-washed, size-profiled graft, nonirradiated bone, long stems as required), and Series 3 (n = 21, modular tamps). Stem subsidence was analyzed with Ein Bild Röntgen Analyse software. Radiographic loosening, complications, and reoperations were also determined.

Results

The median subsidence at 12 months for Series 1, 2, and 3 were 2.1, 0.5, and 0.7 mm at the prosthesis-cement interface and 1.3, 0.1, and 0.1 mm at the cement-bone interface. There were two postoperative Vancouver B periprosthetic fractures in Series 1, four hips were revised for loosening in Series 1, and there were no fractures or loosening in Series 2 and 3 at minimum 2 years’ followup. There were no surviving hips radiographically classified as possibly or probably loose.

Conclusions

Evolution in techniques of femoral impaction grafting in this study were associated with reduced subsidence of the stem at both the prosthesis-cement interface and cement-bone interface when compared to the original series. Concurrent with reduced stem subsidence was the absence of periprosthetic fracture, radiographic loosening, and complications requiring rerevision.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr Roumen Stamenkov, Allograft Bone Fellow; Professor Stephen Graves and Mr Andrew Mintz, Consulting Surgeons; and Sue Pannach for assisting with patient review.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia

    D. W. Howie MBBS, PhD, FRACS, S. A. Callary BAppSc, M. A. McGee BSc, MPh, N. C. Russell MBBS, BE(Hons) & L. B. Solomon MD, PhD, FRACS

  2. Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, Australia

    D. W. Howie MBBS, PhD, FRACS, S. A. Callary BAppSc, M. A. McGee BSc, MPh & L. B. Solomon MD, PhD, FRACS

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  1. D. W. Howie MBBS, PhD, FRACS
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  2. S. A. Callary BAppSc
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Corresponding author

Correspondence to S. A. Callary BAppSc.

Additional information

One or more of the authors (DWH) have received research funding from Zimmer Inc (Warsaw, IN).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with the ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Royal Adelaide Hospital.

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Howie, D.W., Callary, S.A., McGee, M.A. et al. Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty. Clin Orthop Relat Res 468, 3314–3321 (2010). https://doi.org/10.1007/s11999-010-1484-4

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  • DOI: https://doi.org/10.1007/s11999-010-1484-4

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