Abstract
This was an assessment of the clinical and radiological outcome of impaction allografting using morselised cancellous bone allograft in femoral component revision in total hip arthroplasty.
27 consecutive femoral revisions operated on by a single surgeon (SJK) since 1995 were reviewed. Morselised bone allograft was used to reconstitute bone stock deficiency. All patients had cemented Exeter X-change technique Patient selection was primarily based on the amount of preoperative bone loss that was graded according to the Endo-Klinik classification. 10 hips were Endo-Klinik grade 2, 16 hips grade 3 and 1 hip grade 4. Both the components were revised in 18 hips.
The duration of follow up was 12–56 months (average: 33 months) Clinical outcome was assessed using the Charnley modification of Merle d’Aubigné and Postel score. Radiographs were standardised & assessment was done on digitised images of the radiographs using the Image Tool program (Wilcox, Dove, McDavid and Greer, UTHSCSA, Texas, USA).
Charnley’s scores improved from a preoperative score of 2.3, 2.6 and 2.6 to 5.3, 4.2 and 4.8 respectively. Radiologically there were 2 cases of subsidence of > 10mm after 24 months postoperatively. Non progressive radiolucent lines of < 2mm were noted in 7 hips at the cement-graft interface while 3 hips had radiolucent lines at the stem-cement interface. There was satisfactory radiological evidence of bone consolidation in 26 of the cases (95%). There have been 2 re-revisions-1 for dislocation and the other for massive subsidence.
Midterm results showed good functional improvement in hips with preoperative grade 2 and 3 bone loss. We believe this technique is effective in treating major bone loss but may be highly operator dependent.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
