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Femoral stem impaction grafting is durable, reliable for treatment of acetabular defects
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ORLANDO, Fla. — Femoral revision in cemented total hip arthroplasty in patients with Paprosky type IIIb and type IV defects could be aided by impaction grafting, according to a speaker at the Current Concepts in Joint Replacement Winter Meeting, here.
“Revision of the femoral component with impaction grafting is a reliable and durable technique with an acceptably low complication rate with excellent survivorship,” Thorsten Gehrke, MD, said. “In my eyes, it is the best solution for desperate type IV defects.”
Thorsten Gehrke
After removal of the failed stem and cement rests, Gehrke said he uses bone chips with metal mesh to construct solid bone for cementation. He inserts an intermedullary plug, including a central wire distal to the stem tip, adding the bone chips proximally to distally, according to the abstract. Gehrke said he impacts the bone, then inserts a dummy stem as a proximal impactor and space filler.
“It is a nice procedure and you get really good results with short stems even if you had longer stems before,” he said.
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Although the procedure is reliable, the femur should still be protected with wires, he cautioned. Biologically, femoral impaction grafting performed well in a 1987 study in Exeter, United Kingdom, he said. Ten-year survivorship in his group was 98% for aseptic loosening and 84% for all causes. In the Swedish registry during a 15-year period, the results were 99% survivorship for aseptic loosening and 94.5% survivorship for all causes, Gehrke said.
Reference:
Gehrke T. Paper #53. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2012; Orlando, Fla.
Disclosure: Gehrke receives funding from Biomet, Boehringer Ingelheim, Waldemar Link GmbH and Zimmer.