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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 6, 832-836.
doi: 10.1302/0301-620X.88B6.17246  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Reconstruction of femoral defects in revision hip surgery

RISK OF FRACTURE AND STEM MIGRATION AFTER IMPACTION BONE GRAFTING

R. Barker, MBBS, MSc, MRCS, Specialist Registrar in Trauma and Orthopaedics1; T. Takahashi, Research Fellow2; A. Toms, MB, ChB, MSc, FRCS (Trauma & Orth), Consultant Orthopaedic Surgeon3; P. Gregson, MBBS, FRCS (Trauma & Orth), Consultant Orthopaedic Surgeon1; and J. H. Kuiper, PhD, Lecturer4

1 The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Gobowen, Oswestry, Shropshire SY10 7AG, UK.
2 Department of Orthopaedic Surgery, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
3 The Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Trust, Barrack Road, Exeter EX2 5OQ, UK.
4 Institute of Science and Technology, Faculty of Health, Keele University, Staffordshire ST5 5BG, UK.

Correspondence should be sent to Mr R. Barker; e-mail: ross{at}barking62.freeserve.co.uk

The use of impaction bone grafting during revision arthroplasty of the hip in the presence of cortical defects has a high risk of post-operative fracture. Our laboratory study addressed the effect of extramedullary augmentation and length of femoral stem on the initial stability of the prosthesis and the risk of fracture.

Cortical defects in plastic femora were repaired using either surgical mesh without extramedullary augmentation, mesh with a strut graft or mesh with a plate. After bone impaction, standard or long-stem Exeter prostheses were inserted, which were tested by cyclical loading while measuring defect strain and migration of the stem.

Compared with standard stems without extramedullary augmentation, defect strains were 31% lower with longer stems, 43% lower with a plate and 50% lower with a strut graft. Combining extramedullary augmentation with a long stem showed little additional benefit (p = 0.67). The type of repair did not affect the initial stability. Our results support the use of impaction bone grafting and extramedullary augmentation of diaphyseal defects after mesh containment.




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(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General