This article is more than 5 years old. Information may no longer be current.
Failed APCs may be replaced with positive outcomes
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.