Hip revisions with impacted morselized allograft bone and cement. Patient outcome, prosthetic fixation and risks.

Research output: ThesisDoctoral Thesis (compilation)

Abstract

144 consecutive hip revisions performed with morselized allograft bone and cement were followed up to 5 years after surgery. In 49 hips patient outcome was evaluated with the Nottingham Health Profile (NHP) questionnaire and Charnley hip scores in 47 hips prosthetic fixation was evaluated with radiostereometry (RSA)and in all 144 hips risks and complications were recorded using a prspective protocol. Patient outcome regarding pain, physical mobility and sleep at 4 years after revision was comparable to that of primary hip replacements. The correlations between NHP and Charnley pain and physical mobility scores were weak to moderate. RSA index examination should be done as early as possible after surgery. The Exeter stem subsides within the cement mantle and in revisions additional subsidence of the stem-cementbeam occurs relative to the femur. All stems and most sockets migrated, mostly early after revision, without correlation to the grade of bone stock deficiency; one third of the prosthetic components still migrated between 1.5 and 2 years postoperatively. 1 of 15 stems had aseptic loosening according to RSA while the other had migrated only marginally between the 2-year and 5-year follow-up examinations. 5 of 17 sockets had signs of radiographic loosening (radiolucent line >2mm; these sockets were also among those showing the most pronounced migration and rotation at the 5-year follow-up. Neither for the stems nor for the sockets did early migration pattern predict future prosthetic movements. In a pilot study free weight bearing was practised and the migration of the stem and socket was similar to that shown among patients who practised restricted weight bearing for 3 months after revision. Concomitant disease, large bone stock deficiency, intraoperative femoral cortical window or perforation increased the risk for femoral fracture but all 9 hips but could be managed without lasting morbidity.

Details

Authors
  • Ewald Ornstein
Organisations
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Orthopedics

Keywords

  • radiostereometry, NHP, patient outcome, cement, allograft, morselized, impacted, bone transplantation, hip, Arthroplasty, revision, complications, Surgery, orthopaedics, traumatology, Kirurgi, ortopedi, traumatologi
Translated title of the contributionOmoperation av höftleder med malt och packat bentransplantat och cementerad Exeterprotes med X-change revision instruments system
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Assistant supervisor
  • [unknown], [unknown], Supervisor, External person
Award date2002 Oct 4
Publisher
  • Department of Orthopaedics, Lund University
Print ISBNs91-628-5325-2
Publication statusPublished - 2002
Publication categoryResearch

Bibliographic note

Defence details Date: 2002-10-04 Time: 13:30 Place: Röda salongen, Kulturhuset i Hässleholm External reviewer(s) Name: Andersson, Gunnar BJ Title: Professor Affiliation: [unknown] --- Article: I. Quality-of-life outcomes in hip revision arthroplasty with impacted morselized alograft bone and cement: comparison with primary arthroplasty. Atroshi I, Ornstein E, Franzén H, Johnson R, Stefánsdóttir A, Sundberg M. Submitted Article: II. Radiostereometric analysis in hip revision surgery - optimal time for index examination. Ornstein E, Franzén H, Johnsson R, Sundberg M. Acta Orthop Scand 2000; 71(4):360-364. Article: III. Early subsidence of the Exeter femoral stem within the cement mantle in primary arthroplasties and in revisions using impacted allografts and cement: a roentgen stereophotogrammetric analysis. Ornstein E, Franzén H, Johnsson R, Löfqvist T, Stefánsdóttir A, Sundberg M. Hip International 1999;9(3):139-143. Article: IV. Results of hip revision using the Exeter stem, impacted allograft bone and cement (2-year follow-up). Ornstein E, Atroshi I, Franzén H, Johnsson R, Sandquist P, Sundberg M. Clin Orthop 2001; 389:126-133. Article: V. Hip revision arthroplasty using Exeter stem, impacted morselized allograft bone and cement. A prospective and consecutive five-year radiostereometric and radiographic study in 15 patients. Ornstein E, Franzén H, Johnsson R, Karlsson M, Linder L, Sundberg M. Conditionaly accepted for publication in Acta Orthopaedica Scandinavica. Article: VI. Migration of the acetabular component after revision with impacted morselized allografts. A radiostereometric 2-year follow-up analysis of 21 cases. Ornstein E, Franzén H, Johnsson R, Sandquist P, Stefánsdóttir A, Sundberg M. Acta Orthop Scand 1999; 70 (4):338-342. Article: VII. Five-year follow-up of socket movements and loosening after revision with impacted morselized allograft bone and cement. A radiostereometric and radiographic analysis. Ornstein E, Franzén H, Johnsson R, Stefánsdottir A, Sundberg M, Tägil M. Conditionally accepted for publication in the Journal of Arthroplasty. Article: VIII. Hip revisions with impacted morselized allografts: unrestricted weight bearing and restricted weight bearing has similar effect on migration. A radiostereometry analysis. Ornstein E, Franzén H, Johnsson R, Stefánsdóttir A, Sundberg M, Tägil M. Submitted. Article: IX. Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement. Ornstein E, Atroshi I, Franzén H, Johnsson R, Sandquist P, Sundberg M. J Bone Joint Surg Am 2002;84(8):1323-1328.