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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 4,
544-549.
doi: 10.1302/0301-620X.84B4.12484 Copyright © 2002 by British Editorial Society of Bone and Joint Surgery Revision of the femoral prosthesis with impaction allografting and a Charnley stemA 2- TO 12-YEAR FOLLOW-UPF. Piccaluga, MD, Attending Surgeon1; A.González Della Valle, MD, Attending Surgeon1; J. C. Encinas Fernández, MD, Orthopaedic Fellow1; and R. Pusso, MD, Attending Surgeon11 The Hip Surgery Unit, Institute of Orthopaedics ‘Carlos E Ottolenghi’, Hospital Italiano de Buenos Aires, 4215 Potosi Street, Buenos Aires C1199ACK, Argentina. Correspondence should be sent to Dr F. Piccaluga. Impacted morcellised bone allograft and a Charnley stem was used to revise 59 loose femoral components in 57 consecutive patients. Femoral bone loss was rated as Endo-Klinik grade 2 in nine patients, grade 3 in 41, and grade 4 in nine. The immediate postoperative radiographs and those taken at the most recent follow-up were compared for radiolucencies, subsidence and incorporation of the graft. One patient was lost to follow-up and two were not available for radiological analysis. The mean clinical follow-up in 58 procedures was 56.7 months (24 to 144) and the mean radiological review of 56 reconstructions was 54.4 months (24 to 144). An intraoperative femoral fracture occurred in one patient (1.7%) and was successfully treated by strut grafting and cerclage wiring. Extrusion of cement through perforations or incomplete hoop fractures was detected in the postoperative radiographs of ten procedures (17%); none of these patients sustained a complete fracture. Three patients had dislocations (5%) and two (3.5%) developed painful subsidence of the stem which required a further revision. The latest follow-up radiographs in 56 reconstructions showed a well fixed stem and radiological healing of the graft in 52 (93%), and definite loosening in four (7%). Of these four, two were revised again and two were asymptomatic after a follow-up of 120 months each. The mean subsidence in the 52 successful revisions was 0.38 mm (0 to 4). Impaction allografting with a Charnley stem restored bone stock and provided adequate fixation of the stem in 93% of the hips. There was a low rate of rerevision (3.5%) and a low incidence of intraoperative and postoperative complications. This article has been cited by other articles:
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