Impaction Bone-Grafting before Insertion of a Femoral Stem with Cement in Revision Total Hip Arthroplasty. A Minimum Two-Year Follow-up Study* by JOHN.

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Presentation transcript:

Impaction Bone-Grafting before Insertion of a Femoral Stem with Cement in Revision Total Hip Arthroplasty. A Minimum Two-Year Follow-up Study* by JOHN B. MEDING, MERRILL A. RITTER, E. MICHAEL KEATING, and PHILIP M. FARIS J Bone Joint Surg Am Volume 79(12):1834-41 December 1, 1997 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-A: Initial postoperative radiograph of a fifty-seven-year-old man who had impaction bone-grafting before insertion of the femoral stem with cement. Fig. 1-A: Initial postoperative radiograph of a fifty-seven-year-old man who had impaction bone-grafting before insertion of the femoral stem with cement. Cerclage wires were placed prophylactically before impaction. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B: Twenty-six months postoperatively, stress-oriented trabeculae (arrow) have formed, especially medially and about the middle of the stem. Fig. 1-B: Twenty-six months postoperatively, stress-oriented trabeculae (arrow) have formed, especially medially and about the middle of the stem. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-A Radiograph of a sixty-nine-year-old woman, showing loosening of the cup and proximal femoral osteolysis twenty years after a left total hip replacement in which the femoral stem was inserted with cement. Fig. 2-A Radiograph of a sixty-nine-year-old woman, showing loosening of the cup and proximal femoral osteolysis twenty years after a left total hip replacement in which the femoral stem was inserted with cement. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B Two months after revision with impaction bone-grafting, there is abundant allograft and minimum thickness of the cement about the stem. Fig. 2-B Two months after revision with impaction bone-grafting, there is abundant allograft and minimum thickness of the cement about the stem. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-C Three years postoperatively, there is a relative loss of radiodensity of the periprosthetic allograft, consistent with vascular ingrowth. Fig. 2-C Three years postoperatively, there is a relative loss of radiodensity of the periprosthetic allograft, consistent with vascular ingrowth. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A Radiograph of a seventy-six-year-old woman, made twenty-one years after a left total hip replacement in which the stem was inserted with cement. Fig. 3-A Radiograph of a seventy-six-year-old woman, made twenty-one years after a left total hip replacement in which the stem was inserted with cement. There is severe polyethylene wear and associated massive osteolysis of both the femur and the acetabulum, with medial cortical erosion of the femur. JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B: Initial radiograph made after revision with impaction bone-grafting, showing the thin medial cortical shell (arrow). Fig. 3-B: Initial radiograph made after revision with impaction bone-grafting, showing the thin medial cortical shell (arrow). JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C: Three years postoperatively, there has been remodeling and reconstitution of the medial cortical bone (arrow). Fig. 3-C: Three years postoperatively, there has been remodeling and reconstitution of the medial cortical bone (arrow). JOHN B. MEDING et al. J Bone Joint Surg Am 1997;79:1834-41 ©1997 by The Journal of Bone and Joint Surgery, Inc.