Bone Restoration After Revision Hip Arthroplasty with Femoral Bone Defects Using Extensively Porous-coated Stems with Cortical Strut Allografts

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2020 May 29

PMID 32460781

Citations 4

Authors

Zichuan Ding

Tingxian Ling

Ping Mou

Duan Wang

Kai Zhou

Zongke Zhou

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: We 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.

Results: Patients 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.

Conclusion: The 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.

Citing Articles

Atypical Periprosthetic Femoral Fracture Might be Considered a Distinct Subtype of Atypical Femoral Fracture: A Retrospective Study.

Huang K, Zeng Y, Zhang Q, Tan J, Li H, Yang J Orthop Surg. 2024; 16(10):2454-2463.

PMID: 39072929 PMC: 11456720. DOI: 10.1111/os.14174.

Impact of fixation method on femoral bone loss: a retrospective evaluation of stem loosening in first-time revision total hip arthroplasty among two hundred and fifty five patients.

Wagener N, Pumberger M, Hardt S Int Orthop. 2024; 48(9):2339-2350.

PMID: 38822836 PMC: 11347471. DOI: 10.1007/s00264-024-06230-4.

Open reduction and locked compression plate fixation, with or without allograft strut, for periprosthetic fractures in patients who had a well-fixed femoral stem: a retrospective study with an average 2-year follow-up.

Lv H, Guo X, Wang Y, Zhang Z, Zou L, Xue H BMC Musculoskelet Disord. 2022; 23(1):69.

PMID: 35045862 PMC: 8772153. DOI: 10.1186/s12891-022-05008-2.

Minimum ten-year results in revision total hip arthroplasty using titanium fully porous long stem.

Hasegawa M, Tone S, Naito Y, Wakabayashi H, Sudo A Int Orthop. 2021; 45(7):1727-1733.

PMID: 33825004 DOI: 10.1007/s00264-021-05030-4.

References

Kim Y, Park J, Kim J, Rastogi D . High Survivorship With Cementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA. Clin Orthop Relat Res. 2015; 473(9):2990-3000. PMC: 4523544. DOI: 10.1007/s11999-015-4358-y. View

Nadaud M, Griffin W, Fehring T, Mason J, Tabor Jr O, Odum S . Cementless revision total hip arthroplasty without allograft in severe proximal femoral defects. J Arthroplasty. 2005; 20(6):738-44. DOI: 10.1016/j.arth.2004.12.053. View

Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Matsumoto T . Bone remodeling after a mean of 10 years in diaphyseal cortical defects repaired with femoral revision using bypass fixation of extensively porous-coated stems with high stiffness. Eur J Orthop Surg Traumatol. 2015; 25(4):741-7. DOI: 10.1007/s00590-014-1582-1. View

Gruen T, McNeice G, Amstutz H . "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979; (141):17-27. View

Chung L, Wu P, Chen C, Chen W, Chen T, Liu C . Extensively porous-coated stems for femoral revision: reliable choice for stem revision in Paprosky femoral type III defects. Orthopedics. 2012; 35(7):e1017-21. DOI: 10.3928/01477447-20120621-13. View

Callaghan J, Salvati E, Pellicci P, WILSON Jr P, Ranawat C . Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am. 1985; 67(7):1074-85. View

Buttaro M, Costantini J, Comba F, Piccaluga F . The use of femoral struts and impacted cancellous bone allograft in patients with severe femoral bone loss who undergo revision total hip replacement: a three- to nine-year follow-up. J Bone Joint Surg Br. 2012; 94(2):167-72. DOI: 10.1302/0301-620X.94B2.27296. View

Riviere C, Grappiolo G, Engh Jr C, Vidalain J, Chen A, Boehler N . Long-term bone remodelling around 'legendary' cementless femoral stems. EFORT Open Rev. 2018; 3(2):45-57. PMC: 5890130. DOI: 10.1302/2058-5241.3.170024. View

Huang Y, Shao H, Zhou Y, Gu J, Tang H, Yang D . Femoral Bone Remodeling in Revision Total Hip Arthroplasty with Use of Modular Compared with Monoblock Tapered Fluted Titanium Stems: The Role of Stem Length and Stiffness. J Bone Joint Surg Am. 2019; 101(6):531-538. DOI: 10.2106/JBJS.18.00442. View

10.

Head W, Malinin T . Results of onlay allografts. Clin Orthop Relat Res. 2000; (371):108-12. DOI: 10.1097/00003086-200002000-00012. View

11.

Ding Z, Ling T, Yuan M, Qin Y, Mou P, Wang H . Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts. BMC Musculoskelet Disord. 2020; 21(1):218. PMC: 7140549. DOI: 10.1186/s12891-020-03250-0. View

12.

Ding Z, Xu B, Liang Z, Wang H, Luo Z, Zhou Z . Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery. Orthop Surg. 2019; 12(1):153-161. PMC: 7031546. DOI: 10.1111/os.12600. View

13.

Zdero R, Walker R, Waddell J, Schemitsch E . Biomechanical evaluation of periprosthetic femoral fracture fixation. J Bone Joint Surg Am. 2008; 90(5):1068-77. DOI: 10.2106/JBJS.F.01561. View

14.

Sariyilmaz K, Dikici F, Dikmen G, Bozdag E, Sunbuloglu E, Bekler B . The effect of strut allograft and its position on Vancouver type B1 periprosthetic femoral fractures: a biomechanical study. J Arthroplasty. 2014; 29(7):1485-90. DOI: 10.1016/j.arth.2014.02.017. View

15.

Pak J, Paprosky W, Jablonsky W, Lawrence J . Femoral strut allografts in cementless revision total hip arthroplasty. Clin Orthop Relat Res. 1993; (295):172-8. View

16.

Engh C, Massin P, Suthers K . Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990; (257):107-28. View

17.

Mokka J, Keemu H, Koivisto M, Stormi T, Vahlberg T, Virolainen P . Experience of structural onlay allografts for the treatment of bone deficiency in revision total hip arthroplasty. Scand J Surg. 2013; 102(4):265-70. DOI: 10.1177/1457496913491208. View

18.

Lindahl H . Epidemiology of periprosthetic femur fracture around a total hip arthroplasty. Injury. 2007; 38(6):651-4. DOI: 10.1016/j.injury.2007.02.048. View

19.

Barden B, Fitzek J, Huttegger C, Loer F . Supportive strut grafts for diaphyseal bone defects in revision hip arthroplasty. Clin Orthop Relat Res. 2001; (387):148-55. DOI: 10.1097/00003086-200106000-00020. View

20.

Paprosky W, Greidanus N, Antoniou J . Minimum 10-year-results of extensively porous-coated stems in revision hip arthroplasty. Clin Orthop Relat Res. 1999; (369):230-42. DOI: 10.1097/00003086-199912000-00024. View