Abstract
BackgroundRevision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts.MethodsWe retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1–13.5) years.ResultsThe mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7–99.5%) at 10 years.ConclusionOur data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.
Highlights
Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge
The purpose of this study is to report the mean 10year clinical and radiographic results of revision THA with Paprosky type III and type IV femoral bone defects treated using extensively porous-coated stems and cortical strut allografts
The most important finding of our study is that combining extensively porous-coated stems with cortical strut allografts provided satisfactory clinical and radiographic outcomes for patients undergoing revision THA with Paprosky type III and IV femoral bone defects after a minimum follow-up of 8 years
Summary
Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. Femoral bone defects that must be addressed at the time of revision total hip arthroplasty (THA) may result from aseptic loosening, infection, osteolysis, periprosthetic fracture, stress shielding and implant removal [1]. The primary goal of femoral revision is to obtain initial stability of the stems with the ultimate objective being long-term implant survivorship and the restoration of hip function. The remaining diaphyseal bone may be inadequate to support the components, and achieving distal fixation may be difficult, making the revision more challenging. In revision THA, poor femoral bone stock influences functional outcomes, increases the risk of mechanical failure and periprosthetic fracture, and is associated with particular problems if further revision is required [2,3,4,5]. The reliable long-term durability of revision components and the restoration of hip function are of vital importance in revision THA, since the number of relatively young patients with a long-life expectancy increases
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