Abstract
BackgroundStress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear.MethodsWe retrospectively reviewed 47 patients who underwent revision THA using extensively porous-coated stems combined with cortical strut allografts and 75 patients without allografts. The minimum follow-up was 2 years. Femoral bone remodeling signs, including stress shielding, bone restoration in bone defect area, distal cortical hypertrophy, and femoral width, were compared between patients with and without cortical strut allografts. Clinical outcomes were also compared between two groups.ResultsPatients with cortical strut allografts showed less severe stress shielding (P = 0.01) than patients without allografts. Patients with allografts had more osseous restoration in bone defect area than patients without allografts (63.8% vs 30.7%, P < 0.001). Femoral width was significantly higher in femur with allografts than in femur without allografts at the immediate postoperative stage and latest follow-up (both P < 0.001). The hip function score, re-revision rate, and complications were comparable between two groups.ConclusionThe application of cortical strut allografts can decrease the severity of stress shielding, augment osseous restoration in bone defect area and improve femoral bone stock after revision THA using extensively porous-coated stems.
Highlights
Aseptic loosening, infection, osteolysis, periprosthetic fracture, stress shielding, and implant removal can result in femoral bone defects that must be addressed at time of revision total hip arthroplasty (THA)
Small Moderate Large Severity of stress shielding Mild Moderate Severe Distal cortical hypertrophy Bone restoration in the defect area Osseous restoration Constant defects Increasing defects Femoral width* Pre-operation Immediate post-operation Latest follow-up Fixation and stability of the stems Stable bone ingrowth Stable fibrous ingrowth Unstable Re-revision PJI AL periprosthetic femoral fracture (PFF) Harris Hip Score (HHS) Preoperative points Postoperative points Complications Intraoperative fracture Wound infection Postoperative dislocation *P value was analyzed by the paired t test
We found that extensively porous-coated stems with and without cortical strut allografts can both provide satisfactory clinical outcomes after revision THA with bone defects, the most striking finding in our study was that additional application of cortical strut allografts can further decrease the severity of stress shielding, augment osseous restoration in bone defect area, and reconstruct femoral bone stock
Summary
Infection, osteolysis, periprosthetic fracture, stress shielding, and implant removal can result in femoral bone defects that must be addressed at time of revision total hip arthroplasty (THA). Porous-coated stems have been the predominant choice for revision THA with femoral bone defects. They can bypass the proximal bone defect region and achieve scratch fit fixation in the diaphysis and have shown reliable clinical outcomes in revision THA with bone loss [1,2,3,4,5]. Stress shielding and further bone loss of the femur are of great concern after revision THA with extensively porous-coated stems, especially in femur with already extensive bone defects. Stress shielding and bone loss of the femur are of great concern after revision total hip arthroplasty (THA) with extensively porous-coated stems, especially in a femur with already bone loss. The femoral bone remodeling patterns after revision THA with femoral bone defects using extensively porous-coated stems with cortical strut allografts remain unclear
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