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Failed APCs may be replaced with positive outcomes
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Recent study results have shown, after revision hip arthroplasty, failed allograft prosthesis composites may be revised to a new allograft prosthesis composite with a predictable outcome.
Between 1984 and 2011, 21 patients who experienced failure of allograft prosthesis composite (APC) underwent revision hip arthroplasty using a new APC of the proximal femur. Researchers diagnosed APC failure by the presence of pain, limb shortening, reduced function and radiographic signs of nonunion and subsidence. Mean follow-up was 96 months.
Overall, aseptic loosening and infection were causes of failure. After the APC revision, two of the 21 patients failed, and two patients experienced nonunion of their host-allograft bone junction at 7 months.
Survival rates were 83.5% at 5 and 10 years, according to the researchers. Functional outcome showed a significant improvement in Harris hip score, with a mean preoperative score of 17, a mean 1-year postoperative score of 67 and a final follow-up score of 57.
“The ability to revise an APC adds strength to the decision to initially choose the APC as the surgical solution in a situation with significant bone loss, in that it demonstrates a reasonable bailout strategy when needed,” the researchers wrote. “With the increase in the number of revision long stem distal fixation prostheses the future may bring a growing number of revisions of these stems with significant diaphyseal bone loss, where an APC may be the best solution.”
Disclosure: Gross is a paid consultant of Zimmer and is on the editorial board of the Journal of Arthroplasty.
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