J Korean Hip Soc.  2010 Sep;22(3):197-202. 10.5371/jkhs.2010.22.3.197.

Revision Total Hip Arthroplasty with a Strut Allograft and an Extensively Porous-Coated Femoral Stem

• Lee KJ
• Min BW
• Bae KC
• Cho CH
• Kim DH

• KMID: 1461170
• DOI: http://doi.org/10.5371/jkhs.2010.22.3.197

Abstract

PURPOSE
We wanted to report on the outcomes of using a strut allograft and extensively porous-coated femoral stems in revision total hip arthroplasty that was performed due to extensive femoral bone loss.
MATERIALS AND METHODS
Between 1998 and 2005, we performed 167 consecutive revision total hip arthroplasties. Among them, twelve cementless femoral revision surgeries with a strut allograft and extensively porous-coated stems were retrospectively reviewed. The average follow up was 4.6 years. The average age at the time of the index revision was 55.9 years. The reasons for the revisions were periprosthetic fracture due to extensive osteolysis in 5 hips and aseptic loosening in 7 hips.
RESULTS
The Harris hip score improved from a mean of 40.8 points before revision surgery to a mean of 85.1 points at the latest follow up. Radiographic evidence of bony stable stems were present in 11 hips and a fibrous stable stem was present in 1 hip. Moderate stress-shielding was noticed in one hip. Nonunion of the allograft was observed in 1 hip due to deep infection. To date, no significant wear or osteolysis has been observed.
CONCLUSION
Revision total hip arthroplasty with a strut allograft and an extensively porous-coated femoral stem for treating cases of extensive femoral bone loss seems to be a reasonable choice. However, the concerns related to stress shielding, the difficulties in re-revisions and the complications associated with an allograft will require longer term follow up.

Keyword

Femoral bone loss; Revision total hip arthroplasty; Strut allograft; Extensively porous-coated stem

MeSH Terms

Arthroplasty
Follow-Up Studies
Hip
Osteolysis
Periprosthetic Fractures
Retrospective Studies
Transplantation, Homologous

Figure

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  Fig. 1 (A) Preoperative radiograph shows periprosthetic fracture with an extensive osteolysis around the stem. (B) Postoperative radiograph shows an excellent fixation with an extensively porous-coated stem and cortical strut allograft. (C) Radiograph obtained 7 years postoperative shows a consolidation and union of the periprosthetic fracture.

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  Fig. 2 (A) Preoperative radiograph shows diffuse osteolysis around the femoral stem with periprosthetic fracture. (B) Postoperative radiograph shows an excellent fixation of the stem and reconstruction of proximal bone defect with an extensively porous-coated stem and cortical strut allograft. (C) Radiograph obtained 3.3 years after surgery shows union of strut allograft.

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