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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 441-446.
doi: 10.1302/0301-620X.91B4.21319  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Femoral impaction bone grafting with the Exeter stem - the Swedish experience

SURVIVORSHIP ANALYSIS OF 1305 REVISIONS PERFORMED BETWEEN 1989 AND 2002

E. Ornstein, MD, PhD, Consultant Orthopaedic Surgeon1; L. Linder, MD, PhD, Consultant Orthopaedic Surgeon, Professor1; J. Ranstam, PhD, CStat, Director2; S. Lewold, MD, PhD, Consultant Orthopaedic Surgeon1; T. Eisler, MD, PhD, Consultant Orthopaedic Surgeon3; and M. Torper, MD, Senior Registrar1

1 Department of Orthopaedic Surgery, Hässleholm Hospital, SE-28125, Hässleholm, Sweden.
2 Swedish National Competence, Musculoskeletal Centre (NKO) University of Lund, SE-22185, Lund, Sweden.
3 The Swedish Hip Arthroplasty Registry, Sahlgrenska University Hospital, SE-43130 Mölndal, Sweden.

Correspondence should be sent to Dr E. Ornstein; e-mail: ewald.ornstein{at}skane.se

We identified 1305 femoral impaction bone grafting revisions using the Exeter stem performed between 1989 and 2002 in 30 hospitals throughout Sweden. There were 1188 patients with a mean age of 71 years (29 to 94) followed up for between five and 18 years.

The participating departments reported 70 further revisions in total, of which 57 could also be identified on the Swedish National Arthroplasty Registry.

Kaplan-Meier survivorship for all causes of failure was 94.0% (95% confidence interval (CI) 92 to 96) for women and 94.7% (95% CI, 92 to 96) for men at 15 years. Survivorship at 15 years for aseptic loosening was 99.1% (95% CI 98.4 to 99.5), for infection 98.6% (95% CI 97.6 to 99.2), for subsidence 99.0% (95% CI 98.2 to 99.4) and for fracture 98.7% (95% CI 97.9 to 99.2)

Statistically significant predictors of failure were the year in which revision was conducted (p < 0.001). The number of previous revisions was slightly above the level of signifance (p = 0.056). Age, gender, the length of the stem and previous septic loosening were not predictors of failure (p = 0.213, p = 0.399, p = 0.337, p = 0.687, respectively). The difference in survivorship between high- and low-volume departments was only 3% at ten years.

We conclude that impaction bone grafting with the Exeter stem has an excellent long-term survivorship following revision arthroplasty. The technique of impaction grafting appears to be reliable, can be learned rapidly and produces a predictably low incidence of aseptic loosening.




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Femoral impaction bone grafting
A. Ludwig Meiss
J Bone Joint Surg Br Online, 16 Apr 2009 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General