Bone Impaction Grafting Technique Research Articles

The hybrid humerus reverse shoulder arthroplasty: a prospective study of bone grafting and metaphyseal fixation with undersized stem in the assessment of proximal humeral stress shielding and associated clinical outcome

BackgroundA significant proportion of revisions after reverse shoulder arthroplasty (RSA) is attributed to the humeral component. The purpose of this study is to evaluate the radiographic and clinical outcomes of the hybrid humerus technique for RSA using a Grammont-style humeral prosthesis in an onlay fashion with metaphyseal bone impaction grafting technique and undersized stem to avoid humeral stress shielding, notching, and loosening. MethodsThis is a prospective case series of patients who underwent RSA using the hybrid humerus technique with a minimum 2-year follow-up. Key steps of this technique include the use of undersized Grammont-style stem, impaction bone grafting of the proximal 5 cm of the humerus, and adjusting the height and offset of the stem depending on the patient stature, desired lateralization and distalization, and joint and soft tissue tension. Radiographic assessments were performed immediately after surgery, and at 1 and 2 years after surgery. These included assessment of metaphyseal and diaphyseal filling ratio, cortical narrowing, radiolucent lines, cortical lucencies, spot welding, scapular notching, and stem alignment. Preoperative and 2-year postoperative clinical assessments included American Shoulder and Elbow Surgeons score, Constant-Murley Score, University of California Los Angeles score, visual analog scale for pain, and active range of motion. Correlation between the filling ratios and clinical outcomes were also evaluated. ResultsSixty-one patients were included in the study. The average metaphyseal and diaphyseal filling ratio on the postoperative X-ray was 0.66 and 0.54, and 0.67 and 0.54 at 2 years, respectively. Stress shielding was graded as none in 24 (40.7%), mild in 33 (55.9%), and moderate in 2 (3.4%). No stem had a change in position of more than 5°. At 2 years of follow-up, no humeral implant loosening was noted, with only 2 (3.4%) of the stems at risk of loosening. Thirty-nine (66.1%) had no notching, 14 (23.7%) were graded as mild, and 6 (10.2%) had moderate signs of notching. All clinical assessments significantly improved at 2 years (P < .001), with a weak negative correlation between visual analog scale and metaphyseal filling ratio (r = −0.268, P = .036) but none between diaphyseal filling ratio and clinical outcomes. ConclusionThe hybrid humerus technique of metaphyseal bone grafting with a low filling ratio stem presents a promising solution for reducing humeral complications in RSA. This technique demonstrates a low incidence of stress shielding and loosening, with excellent clinical outcomes at 2 years.

Impaction Bone Grafting for Severe Femoral Bone Loss: Surgical Technique in Revision Total Hip Arthroplasty.

The specific steps to perform this procedure include (1) preoperative planning; (2) positioning of the patient and surgical approach; (3) cautious removal of the previous components; (4) preparation of the bone graft; (5) implantation of the appropriate IBG revision system, restoring bone loss from distal to proximal and utilizing metal mesh as needed; (6) implantation of the new stem, bypassing the defect; and (7) aftercare with protected weight-bearing in order to avoid subsidence of the stem and periprosthetic fracture. There are several alternatives to the IBG technique in the setting of revision total hip arthroplasty with extensive femoral bone loss. These alternatives include distal cementless fixation (either modular or nonmodular), a megaprosthesis, or an allograft-prosthesis composite. The rationale for use of the IBG technique is restoration of bone stock. Although this issue may be irrelevant in low-demand elderly patients, we believe it is of the utmost importance among young (i.e., <60 years old) and active patients. This technique is versatile enough to be utilized in different scenarios such as periprosthetic fracture, periprosthetic joint infection (2-stage protocols), and aseptic loosening. We have reported favorable clinical and radiographic outcomes for the treatment of both aseptic and septic femoral component loosening. In all cases, we utilized vancomycin-supplemented impacted cancellous allograft without evidence of secondary effects with regard to bone incorporation, nephrotoxicity, or allergic reactions. Although it was initially contraindicated, we further extended the indication for this reconstruction alternative to cases of circumferential proximal bone loss with non-neoplastic bone defects of ≤15 cm, utilizing encompassing metal mesh and a bypassing long stem. Recently, we reported on poorer outcomes following IBG compared with the use of uncemented modular stems for the treatment of type B3 periprosthetic femoral fractures, with a significantly higher rate of infection and implant breakage for the former treatment. Nowadays, we advocate the use of this technique in young, active patients (i.e., <60 years old) with a femoral bone defect Paprosky grade IIIB or IV, in which reconstitution of bone stock is crucial to avoid an eventual implant failure in the long term. This technique requires an experienced team. This procedure should be avoided in the presence of active periprosthetic joint infection.The gluteus maximus tendon should be detached to avoid tensioning the sciatic nerve and to decrease the chance of periprosthetic femoral fracture.Massive bone loss can jeopardize correct implant orientation and restoration of biomechanics. In this scenario, surgeons might consider the intercondylar axis as a guide for femoral version.Try to avoid (if possible) trochanteric or extended trochanteric osteotomy because proximal bone stock is necessary to contain the bone grafts. In some cases, such as those in which the removal of the stem is difficult, especially with certain uncemented stem designs, an extended trochanteric osteotomy must be performed. Whether or not a cemented stem is removed, it is mandatory to remove all remaining cement in the femoral canal.Preoperative templating is a necessity to reconstruct leg length. Accurately determining the length of the mesh is the most important step to avoid shortening or overlengthening of the lower extremity.Approximately 10 cm of circumferential metal mesh should be fixed with 3 to 5 double cerclage metal wires to the remaining bone. The new femoral stem should bypass extend beyond the mesh for approximately 5 cm. If the stem does not bypass the mesh, there is an increased risk of postoperative fracture.In order to decrease the risk of intraoperative femoral fracture, the distal aspect of the femur should be secured with cerclage wires, and the proximal aspect of the femur should also be protected with cerclage wires over the mesh. As in any other complex femoral revision procedure, torsional forces in the supracondylar zone should be avoided, especially during trial or stem reduction maneuvers.Always utilize a bone graft mixed with antibiotic powder.Retrograde cementation must be done with cement that is in a more liquid state than in primary total hip arthroplasty. PO = postoperativePMMA = polymethyl methacrylateIV = intravenousLMWH = low molecular weight heparinDVT/EP = deep vein thrombosis and extended prophylaxis.

Bone impaction grafting and anti-protrusio cages in high-grade acetabular defects: a 22-year single centre experience.

Report clinical and radiological long-term follow-up (FU) outcome of bone impaction grafting (BIG) and anti-protrusio cage (APC) technique in hip revision surgery. We analysed data on complications, as well as the clinical and radiological outcome of patients treated using this technique at our institution. We evaluated the acetabular bone stock renovation, acetabular component stability and its radiological migration. The clinical parameters considered were the Visual Analogue Scale (VAS) and the modified Harris Hip Score (mHHS). Forty hips, with a mean 14.3-year FU, were included. This technique showed good clinical long-term results in an elderly and low-demanding population (mean age at surgery 71.4 ± 12.1years). The radiological results were not as good as clinical results: 67.5% of cases had a radiographic evidence of resorption of less than 1/3 of the bone graft; 27.5% had a resorption ranging from 1/3 and ½ of the graft, and 5% had more than ½ of the graft. Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC (p < 0.001). The survival rate was 95% and a 2.5% rate of septic failure was recorded. Impaction grafting with femoral head and APC is an effective technique for treating high-grade acetabular defects. APC reconstructs the hip centre of rotation, avoiding loading forces on the underlying bone graft that can be correctly integrated. At long-term FU, satisfactory clinical results, not strictly correlated to radiological signs of integration, were observed; Paprosky type III B reported worse results in terms of graft resorption and a greater migration of the APC.

Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique

BackgroundAcetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results.MethodsThis was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.ResultsImprovement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.ConclusionThe combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.

Impaction Bone Grafting or Uncemented Modular Stems for the Treatment of Type B3 Periprosthetic Femoral Fractures? A Complication Rate Analysis

BackgroundBecause the gold standard for the treatment of Vancouver type-B3 periprosthetic femoral fractures (PFFs) is yet to be defined, we sought to analyze the complication rate between the impaction bone grafting (IBG) technique with a cemented stem and reconstruction with an uncemented distally-fixed modular stem (DFMS). MethodsWe retrospectively studied 54 B3 PFFs operated between 2000 and 2016, comparing the complication rate of 33 patients treated with the IBG technique (group A) with 21 patients treated with a DFMS (group B). Median follow-up of groups A and B were 75 months (interquartile range [IQR], 36-111 months) and 55 months (IQR, 32-73 months), respectively (P = .008). Median age of groups A and B were 78 years (IQR, 74-83 years) and 81 years (IQR, 74-86 years), respectively (P = .30). Median grade of Endo-Klink femoral bone defect was 3 (IQR, 3-3) for both groups (P = .11). We performed a multiple regression analysis to determine risk factors for complications including the following variables: age, initial diagnosis, and surgical technique. ResultsAs for infection outcomes, 2-stage revision surgery was more frequent in group A than in group B (4 vs 0, P = .003). Group A presented more implant failures than group B (5 vs 1, P = .195). We found 4 dislocations in group B and 2 in group A (P = .192). Multiple regression analysis showed a significant association between surgical technique and complication rate (P = .01). The IBG technique presented an odds risk for complications of 4.77 (P = .016; IQR, 1.33-17.21). ConclusionFemoral reconstruction with the IBG technique evidenced an ostensibly higher complication rate than that of DFMS for the treatment of B3 PFF.

Locally administered bisphosphonate in hip stem revisions using the bone impaction grafting technique: a randomised, placebo-controlled study with DXA and five-year RSA follow-up.

Bisphosphonates have previously been shown to increase the density of impacted graft bone. In the present study we hypothesise that bisphosphonates also reduce early stem subsidence. We examined the effect of locally applied bisphosphonate to allografts on prosthetic micromotion and bone density in femoral stem revision with impaction grafting. 37 patients were randomised to either clodronate or saline as local adjunct to the morsellised allograft bone. 24 patients were finally analysed per protocol and evaluated by dual-energy x-ray absorptiometry (DXA) during the first year and with radiostereometric analysis (RSA) for 5 years. There were no significant differences neither in bone density, nor in migratory behaviour between the groups. The femoral stems had subsided 3.6 mm in both groups (p = 0.99) at 5 years and there was no difference as measured over time with mixed models analysis. The clinical outcome was good in both groups. Clodronate as a local addendum to allograft bone in hip revision did not increase bone density or reduce micromotion of the implant.

Decreased migration with locally administered bisphosphonate in cemented cup revisions using impaction bone grafting technique

Background and purpose — Impaction bone grafting (IBG) in revision hip surgery is an established method in restoring bone stock deficiencies. We hypothesized that local treatment of the morsellized allograft with a bisphosphonate in cemented revision would, in addition to increased bone density, also reduce the early migration of the cup as measured by radiostereometry (RSA).Patients and methods — 20 patients with aseptic cup loosening underwent revision using the IBG technique. The patients were randomized to either clodronate (10 patients) or saline (10 patients, control group) as local adjunct to the morsellized bone. The outcome was evaluated by dual-energy X-ray absorptiometry (DXA) during the first year regarding periacetabular bone density and with radiostereometric analysis (RSA) for the first 2 years regarding cup migration.Results — 2 patients were lost to follow-up: 9 patients remained in the clodronate and 9 in the control group. Less proximal migration was found in the clodronate group compared with the controls, measured both over time (mixed-models analysis, p = 0.02) as well as at the specified time points up to 2 years (0.22 mm and 0.59 mm respectively, p = 0.02). Both groups seemed to have stabilized at 1 year. We found similar bone mineral density measured by DXA, and similar RSA migration in the other directions. No cups were re-revised.Interpretation — Local treatment of the allograft bone with clodronate reduced early proximal migration of the revised cup but without any measurable difference in periacetabular bone density.

Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty

Periacetabular bony defects remain agreat challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of asuitable implant the primary stable fixation and sufficient biological reconstitution of asustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. In the field of biological augmentation several methods are currently available. Autologous transplants feature aprofound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

A Compaction Bone Grafting Technique Leads to Early Bone Fusion in Cases of Posterior Lumbar Interbody Fusion.

The impaction bone grafting technique is a popular approach for achieving complete bone fusion during hip surgery or total knee arthroplasty. We hypothesized that compaction bone grafting (CBG), a modified version of impaction bone grafting, could be applied to lumbar fusion surgery. To compare the bone fusion rates and durations achieved using the CBG technique and a conventional loose bone grafting technique. We retrospectively reviewed 89 patients who underwent single-level posterior lumbar interbody fusion at the university hospital; 35 other posterior lumbar interbody fusion recipients were excluded due to undergoing multilevel fusion, prior lumbar surgery, trauma, infection, or inadequate computed tomographic data. Computed tomographic-based bone fusion assessments were obtained using the Brantigan, Steffee, and Fraser criteria at 1 and 2 years after surgery. The baseline characteristics of the CBG (n = 42) and loose bone grafting (n = 47) groups did not significantly differ. Fusion assessments indicated that significantly superior bone fusion rates were achieved at 1 year after surgery in the CBG group than in the loose bone grafting group (P = .04, χ2 test). However, the bone fusion rates of the 2 groups at 2 years after surgery did not significantly differ (P = .3). A nonsymptomatic surgical complication occurred in the CBG group when a spacer was inserted into the intervertebral space; specifically, the spacer slipped out of the right psoas muscle because a large quantity of compaction bone grafts disrupted the cage's pathway. In posterior lumbar interbody fusion surgeries, bone fusion was achieved more quickly with the CBG technique than with the conventional technique.

Fracture of the C-Stem cemented femoral component in revision hip surgery using bone impaction grafting technique: report of 9 cases.

We present a series of 9 fractures of a C-Stem femoral component (6 long stems and 3 conventional stems) that had been implanted with the use of impaction bone grafting (IBG). The length of the long fractured stems was 240 mm in 4 cases and 200 mm in 2. The patients presented had an average BMI of 26.5 and an average of 2.7 previous hip surgeries (range 2-5 surgeries) before the stem fracture. A total of 5 cases presented with a metal mesh fracture in addition to the fractured stem. Bending of the stems or stem defects was not observed in any case. Typical fracture waves consistent with fatigue failure were clearly visible on all the cut surfaces, starting anterolaterally and propagating to the medial side. Although fatigue fracture of a modern cemented tapered polished femoral stem is a rare event, stress due to the absence of proximal femoral bone support could be sufficient to put this stem at a higher risk for fatigue fracture in non-obese patients.

Porous titanium particles for acetabular reconstruction in total hip replacement show extensive bony armoring after 15 weeks

Background and purpose — The bone impaction grafting technique restores bone defects in total hip replacement. Porous titanium particles (TiPs) are deformable, like bone particles, and offer better primary stability. We addressed the following questions in this animal study: are impacted TiPs osteoconductive under loaded conditions; do released micro-particles accelerate wear; and are systemic titanium blood levels elevated after implantation of TiPs?Animals and methods — An AAOS type-III defect was created in the right acetabulum of 10 goats weighing 63 (SD 6) kg, and reconstructed with calcium phosphate-coated TiPs and a cemented polyethylene cup. A stem with a cobalt chrome head was cemented in the femur. The goats were killed after 15 weeks. Blood samples were taken pre- and postoperatively.Results — The TiP-graft layer measured 5.6 (SD 0.8) mm with a mean bone ingrowth distance of 2.8 (SD 0.8) mm. Cement penetrated 0.9 (0.3–1.9) mm into the TiPs. 1 reconstruction showed minimal cement penetration (0.3 mm) and failed at the cement-TiP interface. There were no signs of accelerated wear, metallic particle debris, or osteolysis. Median systemic titanium concentrations increased on a log-linear scale from 0.5 (0.3–1.1) parts per billion (ppb) to 0.9 (0.5–2.8) ppb (p = 0.01).Interpretation — Adequate cement pressurization is advocated for impaction grafting with TiPs. After implantation, calcium phosphate-coated TiPs were osteoconductive under loaded conditions and caused an increase in systemic titanium concentrations. However, absolute levels remained low. There were no signs of accelerated wear. A clinical pilot study should be performed to prove that application in humans is safe in the long term.

The Evolution of the Technique of Impaction Bone Grafting in Femoral Revision Surgery has Improved Clinical Outcome. A Prospective Mid-Term Study

Ninety-three patients (97 hips) underwent impaction bone grafting (IBG) using a cemented tapered femoral stem at our institution. Forty-one hips were operated between 1993 and 1998 (group 1) and 56 hips between 1999 and 2007 (group 2). The use of an extended trochanteric osteotomy and a long stem was more frequent in group 2. Group 2 hips showed a better clinical result. One hip was revised for aseptic loosening and most failures were early periprosthetic fractures. The survival rate for reoperation for any cause was 82.9% for group 1 and 84.3% for group 2. Patients in group 1 had a higher risk for periprosthetic fractures and radiological subsidence >5mm. Experience and the evolution of the IBG technique have improved the good long-term outcome.

The role of large femoral head components in revision of total hip arthroplasty

To study the efficiency of decreasing instability of large femoral head components in revision total hip arthroplasty (THA). From August 2005 to December 2010, 107 patients (112 hips) with 28 mm femoral head components (28 mm group) and 46 patients (46 hips) with 36 mm femoral head components (36 mm group) in revision THA were analyzed retrospectively in order to find if the dislocation rate and Harris hip score were different between the two groups at the time of last follow-up. All the operations were performed by the first author. There were 81 male patients (85 hips) and 26 female patients (27 hips) in 28 mm group with mean age of (62±17) years (26-79 years) and 33 male patients (33 hips) and 13 female patients (13 hips) in 36 mm group with mean age of (60±16) years (31-77 years). The mean follow-up period was 43.3 months (33-71 months) for 28 mm group and 26.7 months (12-37 months) for 36 mm group. There were 7 patients dislocated after revision in 28 mm group, including 2 revised with reinforcement rings (with dislocation rate 9.5%), 3 revised with impaction bone grafting technique (with dislocation rate 8.3%) and 2 revised with cementless cups (with a dislocation rate 3.6%). The dislocation rate of this group was 6.2%. While the dislocation rate of 36 mm group was 2.2%, the only dislocated patient was because of loss of gluteus medius muscle function in the index operation. If this case was excluded, the dislocation rate of 36 mm group would be 0. There was significant difference between the two groups (χ2=103.0095, P<0.01). The Harris hip score was 88±11 for 28 mm group and 89±9 for 36 mm group, there was no significant difference between the two groups (P>0.05). The large femoral head components can significantly decrease the instability after revision THA, which should be used in revision THA.

Biomechanical Analysis of Acetabular Defects Reconstruction with Impaction Bone Grafting in Revision Total Hip Arthroplasty

An objective of this study is to investigate the influence of an amount of mixture of hydroxyapatite (HA) granules and morsellised cancellous bone (MCB) on the initial stability of reconstructed acetabulum through mechanical testing. Reconstruction was carried out using impaction bone grafting technique with four mixture ratio, then, cyclically loaded as a simulation of the motion of gait and analyzed the migration. The initial stability is highly dependent on mixture ratio and larger HA mixture ratio could give us better initial stability of the cup.

Impacted Bone Allografts and a Cemented Stem after Failure of an Uncemented Stem: Preliminary Results

We reviewed the results of impaction bone grafting technique and a cemented stem in 27 consecutive patients with a failed uncemented femoral component. At an average follow-up of 55 months (25 to 94) none of the femoral components were removed or revised because of aseptic loosening or deep infection. In one hip a non progressive radiolucent line was observed in Gruen zone 5 with no clinical evidence of failure. The average postoperative Merle d'Aubigné and Postel Hip Score was 5.8 points for pain, 5.5 points for mobility and 5.4 points for gait. Revision of a failed uncemented stem with impaction grafting technique provided pain relief and improved function. The rate of success and restoration of bone stock were encouraging at mid-term follow-up.

Management of Periprosthetic Femur Fractures With Severe Bone Loss Using Impaction Bone Grafting Technique

We present a technique of femoral impaction grafting used for the treatment of periprosthetic femur fractures with severe bone loss after total hip arthroplasty. Seven patients with femoral fractures with compromise of the femoral isthmus were treated with femoral component revision using the impaction grafting bone technique. The average age was 64 years (range, 44-72 years), and 2 patients required mesh augmentation at the time of surgery. The average follow-up for this group of patients was 56 months (range, 39-92 months). Radiographic evaluation revealed healed fractures in all patients and no evidence of implant loosening at a mean of 56 months (range, 39-92 months). There were no cases of infections or dislocations in this series. Impaction grafting technique can be useful in the treatment of periprosthetic femur fractures when bone loss and canal geometry preclude the use of fully coated femoral components.

Reconstruction of the severe acetabular bone defect by using metal mesh and impaction bone grafting technique

To evaluate the medium-term clinical results of reconstruction of the severe acetabular bone defect by using metal mesh and impaction bone grafting (IBG) technique, as well as to emphasize the importance of Paprosky acetabular bone defect classification system in assessing the severity of bone defect and to analyse the failure reasons. Between December 1998 and December 2007, 67 total hip arthroplasty (THA) revisions were made by using IBG technique to reconstruct severe acetabular bone defects combining with metal mesh or meta mesh cup on 63 patients. All the defects were combined defect (AAOS Type 3). There were 20 Paprosky II B defects in 19 patients, 28 Paprosky II C defects in 29 patients and 13 Paprosky II A defects in 12 patients. Regular follow-ups, involving the assessments of Harris hip scoring system, clinical efficacy, imaging and complications, were subsequently made. Sixty-one hips in 58 patients gained an average of 63 months (8-107) follow-up. Harris hip score increased from an average of 41.7 points (21-52) preoperatively to an average of 89.2 points (81-98) at the last follow-up, with an excellent and good rate of 93%. Radiographically, there were no loosening cases excluding the 3 dislocated polyethylene cups from the metal mesh cups. One case was failed to reconstruction the height of normal hip center, in which metal mesh cup was used for enforce the medial wall. Dislocations occurred in 3 hips, 1 of these patients required an open reduction and the other 2 dislocations only need close reduction. Postoperative infection rate was 1.6% (1 case), two stage revision with another IBG procedure succeeded in this patient. IBG combing with metal mesh for reconstruction of severe acetabular bone defect is an ideal technology. Paprosky acetabular bone defect classification system is very important in IBG procedure besides AAOS acetabular bone defect classification system to evaluate the severity of bone defect and to compare the outcomes between different authors. The use of metal mesh cup should be avoided to enforce acetabular medial wall in patients with severe acetabular bone defect.

Bipolar migrationに対するImpaction bone graftingを併用した人工股関節再置換術

Bipolar migrationに対するImpaction bone graftingを併用した人工股関節再置換術

Impaction bone grafting procedure with distal fixation of a cemented stem with a moldered mesh: a prospective study with a 12.5-year follow-up

A modified version of the impaction bone grafting technique was introduced in 1985. The use of a moldered metallic mesh to protect the graft from excessive cement penetration was promoted as well as to reinforce the reconstruction mechanically. The length of the revision stem was chosen to achieve distal fixation and to bridge the bone loss to prevent subsidence and postoperative femoral shaft fracture. The 8-year stem survivorship was 100% and 92.8 ± 6.8% at 12.5 years of follow-up. This technique achieved cortical and cancellous reconstruction in every case without postoperative femoral shaft fracture or significant subsidence. The clinical and radiological results are long lasting. However, the duration of surgery and the risk of viral agent’s transmission by using extensive bone grafting may restrict the use of this technique.

Favorable Survival of Acetabular Reconstruction With Bone Impaction Grafting in Dysplastic Hips

Acetabular bone loss hampers implantation of a total hip arthroplasty in patients with developmental dysplasia of the hip. The bone impaction grafting technique in combination with a cemented total hip can restore the bone stock in these patients, but do these reconstructions yield satisfying long-term results? We used this technique in 28 hips (22 consecutive patients). The degree of dislocation was graded preoperatively as Crowe I in five hips, Crowe II in eight hips, Crowe III in nine hips, and Crowe IV in four hips. We present the long-term results of this bone impaction grafting technique a minimum of 10 years after surgery. Two patients died before the minimum followup of 10 years, leaving 20 patients (26 hips). Two cups were revised, one cup for a sciatic nerve palsy (at 2 years) and the other for aseptic loosening after 12 years. The cumulative survival of the cup with revision for any reason as the end point was 96% at 10 years and 84% at 15 years. There were no femoral revisions during followup. The bone impaction grafting technique in combination with a cemented cup is an effective technique for developmental dysplasia of the hip with favorable long-term results. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.