Hip Pelvis.  2018 Mar;30(1):23-28. 10.5371/hp.2018.30.1.23.

Medium- to Long-term Results of Strut Allografts Treating Periprosthetic Bone Defects

Affiliations
  • 1Department of Orthopaedic Surgery, Inha University School of Medicine, Incheon, Korea. moon@inha.ac.kr

Abstract

PURPOSE
We evaluated the medium- to long-term outcomes of cortical strut allografts used to treat periprosthetic bone defects to better understand the correlation between radiological and clinical outcomes.
MATERIALS AND METHODS
We retrospectively reviewed outcomes from 19 patients undergoing cortical strut allografts to treat periproshtetic bone defects from 2001 to 2015. The mean age at index operation was 59.4 years and the average follow-up period was 8.6 years. Surgeries were performed because of aseptic loosening (n=9), periprosthetic fractures (n=5), and infections (n=5). Each case was characterized and described in detail including the length of allograft and the union period; possible correlations between allograft length and detailed classification and union period was analyzed. Clinical evaluations included the Harris hip score and Kaplan-Meier survivorship.
RESULTS
In revision total hip arthroplasty (THA), the average length of allografts used in patients experiencing fractures was significantly longer than those with aseptic loosening or infection. Of the 19 cases, incorporation was observed in 18 cases (94.7%). The average time to incorporation was 21.2 months and the time to incorporation was not significantly different among the two groups (fracture vs. aseptic loosening or infection). No positive correlation was identified between the length of allograft and incorporation period or in the time to cortical strut allograft incorporation among Paprosky or Vancouver subgroups.
CONCLUSION
Results of cortical strut allografts show excellent incorporation rates based on medium- to long-term follow-up. Cortical strut allografts may be considered useful for the treatment of femoral bone defects experienced during revision THA and following periprosthetic fracture.

Keyword

Cortical strut allograft; Hip replacement arthroplasty; Periprosthetic fractures

MeSH Terms

Allografts*
Arthroplasty, Replacement, Hip
Classification
Follow-Up Studies
Hip
Humans
Periprosthetic Fractures
Retrospective Studies
Survival Rate

Figure

  • Fig. 1 A 65-year-old male patient who underwent revision total hip arthroplasty (THA) with cortical strut allograft due to infection of previously existing THA. (A) Preoperative X-rays demonstrate infection near the site of a previous THA. (B) Revision THA was undertaken following measures to control infection; cortical strut allograft was performed to stabilize areas of bone defect. (C) Complete incorporation was observed after 30 months.

  • Fig. 2 A 43-year-old male patient suffering from a periprosthetic fracture resulting from a fall underwent open reduction, internal fixation and cortical strut allograft. (A) Preoperative X-ray reveals a Vancouver type B1 fracture. (B) Anterior posterior and axial views of the femur following open reduction, internal fixation and cortical strut allograft. (C) One-year postoperative X-ray showing complete incorporation.

  • Fig. 3 Kaplan-Meyer survival curve. The survival rate at the final follow-up was 94.7% when the endpoint was set as the time of nonunion and removal of cortical strut allograft.


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