Ana Cruz-Pardos

The evolution of the technique of impaction bone grafting in femoral revision surgery has improved clinical outcome. A prospective mid-term study.

Ninety-three patients (97 hips) underwent impaction bone grafting (IBG) using a cemented tapered femoral stem at our institution. Forty-one hips were operated between 1993 and 1998 (group 1) and 56 hips between 1999 and 2007 (group 2). The use of an extended trochanteric osteotomy and a long stem was more frequent in group 2. Group 2 hips showed a better clinical result. One hip was revised for aseptic loosening and most failures were early periprosthetic fractures. The survival rate for reoperation for any cause was 82.9% for group 1 and 84.3% for group 2. Patients in group 1 had a higher risk for periprosthetic fractures and radiological subsidence >5mm. Experience and the evolution of the IBG technique have improved the good long-term outcome.

Current Arthroplasty Options in the Young Adult Hip

Total hip arthroplasty (THA) remains a concern in young patients as a result of the high revision rates associated with the procedure [2, 3]. Although other options have been considered, such as osteotomies, short-stemmed uncemented hip prostheses, and hip resurfacing arthroplasty, THA remains the most frequent indication for a large number of cases and surgeons [4]. Cemented, hybrid, and uncemented implants have been used for the young patient population with substantial variations as regards long-term results and aseptic loosening rates of the acetabular cup [3, 5–10], which most commonly occurs due to polyethylene wear and constitutes the most frequent reason for revision [6–8, 11, 12]. The belief that the osteolysis observed in cemented prostheses more than 10 years postsurgery was caused by cement failure (“cement disease”) [13], which led to the recommendation of cementless implants for young patients.