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Hip revision with impacted morselized allografts: unrestricted weight-bearing and restricted weight-bearing have similar effect on migration

A radiostereometry analysis

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Abstract

Background

No consensus exists as to whether to let patients bear weight or not after revision of a loosened hip prosthesis using morselized and impacted allograft bone and cement. In the original description of the method, the patients were advised not to bear weight for 3 months postoperatively. Theoretically, bone graft remodeling is enhanced by mechanical load, but an increased migration of the prosthesis within the graft can also be anticipated. In addition, practicing restricted weight-bearing is cumbersome for the patients.

Methods

The present study was initiated to evaluate the migration, as measured by radiostereometry analysis (RSA), in patients mobilized with unrestricted weight-bearing after a hip revision using the X-change Revision Instruments System. This group was compared with a previous series with restricted weight-bearing for the initial 3 months postoperatively. Seven stems and 12 sockets were evaluated by RSA over 2 years. Only patients without intraoperative complications were mobilized with unrestricted weight-bearing.

Results

All 7 stems migrated in the distal direction (median 2.6 mm; range 0.8–16.5 mm) and in the posterior direction (median 2.3 mm; range 0.7–22.1 mm). Eleven of the 12 sockets migrated in the proximal direction (median 2.5 mm; range 0.2–8.1 mm). The migration rate decreased gradually in all directions, but 3 stems and 5 sockets still migrated between the 1.5- and 2-year follow-ups. There were no significant differences in migration in any direction for either the stems or the sockets compared to the group with restricted weight-bearing.

Conclusion

No increased migration occurred in the group free to bear weight as compared to restricted weight-bearing. We shall continue to allow unrestricted weight-bearing in cases where the femoral bone feels competent to withstand the initial load. It simplifies the postoperative mobilization, and we speculate that it might increase the remodeling of the graft.

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References

  1. Brewster NT, Gillespie WJ, Howie CR, Madabhushi SP, Usmani AS, Fairbairn DR (1999) Mechanical considerations in impaction bone grafting. J Bone Joint Surg Br 81:118–124

    Article  CAS  PubMed  Google Scholar 

  2. Buma P, Lamerigts N, Schreurs BW, Gardeniers J, Versleyen D, Slooff TJ (1996) Impacted graft incorporation after cemented acetabular revision. Histological evaluation in 8 patients. Acta Orthop Scand 67:536–540

    CAS  PubMed  Google Scholar 

  3. Burchardt H (1983) The biology of bone graft repair. Clin Orthop 174: 28–42

    PubMed  Google Scholar 

  4. Charnley J (1979) Low friction arthroplasty of the hip. Springer Verlag, Berlin Heidelberg New York

  5. Eldridge JD, Hubble MJ, Nelson K, Smith EJ, Learmonth ID (1997) The effect of bone chip size on the initial stability following femoral impaction grafting. Annual meeting of European Orthopaedic Research Society, Barcelona, Spain

  6. Enneking WF, Mindell ER (1991) Observations on massive retrieved human allografts. J Bone Joint Surg Am 73:1123–1142

    CAS  PubMed  Google Scholar 

  7. Frost HM (1964) The laws of bone structure. Charles C. Thomas, Springfield, IL, USA

  8. Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ (1993) Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br 75:14–21

    CAS  PubMed  Google Scholar 

  9. Gruen TA, McNeice GM, Amstutz HC (1979) 'Modes of failure' of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop 141:17–27

    PubMed  Google Scholar 

  10. Gustilo RB, Pasternak HS (1988) Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop 235:111–119

    PubMed  Google Scholar 

  11. Linder L (2000) Cancellous impaction grafting in the human femur: histological and radiographic observations in 6 autopsy femurs and 8 biopsies. Acta Orthop Scand 71:543–552

    Article  CAS  PubMed  Google Scholar 

  12. Nelissen RG, Bauer TW, Weidenhielm LR, LeGolvan DP, Mikhail WE (1995) Revision hip arthroplasty with the use of cement and impaction grafting. Histological analysis of four cases. J Bone Joint Surg Am 77:412–422

    CAS  PubMed  Google Scholar 

  13. Ornstein E, Franzen H, Johnsson R, Sandquist P, Stefansdottir A, Sundberg M (1999) Migration of the acetabular component after revision with impacted morselized allografts: a radiostereometric 2-year follow-up analysis of 21 cases. Acta Orthop Scand 70:338–342

    CAS  PubMed  Google Scholar 

  14. Ornstein E, Franzen H, Johnsson R, Sundberg M (2000) Radiostereometric analysis in hip revision surgery—optimal time for index examination: 6 patients revised with impacted allografts and cement followed weekly for 6 weeks. Acta Orthop Scand 71:360–364

    Article  CAS  PubMed  Google Scholar 

  15. Ornstein E, Franzen H, Johnsson R, Sandquist P, Sundberg M (2001) Results of hip revision using the Exeter stem, impacted allograft bone and cement. Clin Orthop 389:126−133

    PubMed  Google Scholar 

  16. Selvik G (1989) Roentgen stereophotogrammetry. A method for the study of the kinematics of the skeletal system. Acta Orthop Scand [Suppl] 232:1–51

    Google Scholar 

  17. Slooff TJ, Buma P, Schreurs BW, Schimmel JW, Huiskes R, Gardeniers J (1996) Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop 323:108–115

    Google Scholar 

  18. Tägil M, Aspenberg P (2001) Fibrous tissue armoring increases the mechanical strength of an impacted bone graft. Acta Orthop Scand 72:78–82

    Article  PubMed  Google Scholar 

  19. Ullmark G, Hovelius L, Strindberg L, Wallner A (2000) Reduced bleeding through temporary balloon occlusion in hip and knee revision surgery. Acta Orthop Scand 71:51–54

    Article  CAS  PubMed  Google Scholar 

  20. Wang JS, Tägil M, Aspenberg P (2000) Load-bearing increases new bone formation in impacted and morselized allografts. Clin Orthop 378:274–281

    PubMed  Google Scholar 

  21. Wolff J (1986) The law of bone remodelling. Springer Verlag, Berlin Heidelberg New York

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Acknowledgements

This study was supported by the Region of Scania and the Swedish Medical Research Council (no. 17x-09509). We thank Agenta Nilsson for the radiographs necessary for RSA and Håkan Leijon for computerizing the RSA pictures.

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Authors and Affiliations

  1. Department of Orthopedics, Hässleholm-Kristianstad County Hospital, 28125, Hässleholm, Sweden

    Ewald Ornstein, Anna Stefánsdóttir & Martin Sundberg

  2. Department of Orthopedics, Ängelholm County Hospital, 26281, Ängelholm, Sweden

    Herbert Franzén

  3. Department of Orthopedics, Lund University Hospital, 22185, Lund, Sweden

    Ragnar Johnsson & Magnus Tägil

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  1. Ewald Ornstein
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  2. Herbert Franzén
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  3. Ragnar Johnsson
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  4. Anna Stefánsdóttir
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  5. Martin Sundberg
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  6. Magnus Tägil
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Correspondence to Ewald Ornstein.

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Ornstein, E., Franzén, H., Johnsson, R. et al. Hip revision with impacted morselized allografts: unrestricted weight-bearing and restricted weight-bearing have similar effect on migration. Arch Orthop Trauma Surg 123, 261–267 (2003). https://doi.org/10.1007/s00402-003-0499-7

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