Revision Hip Arthroplasty Using Femoral Impaction Bone Grafting with Locking Compression Plate : a Report of Two Cases

Abstract

Introduction: Revision total hip arthroplasty (THA) with femoral bone deficiency poses a considerable challenge to the orthopaedic surgeon. When the proximal femur is deficient, there are few options for reconstruction, including long distal fixation uncemented implants, proximal femur replacement stems, allograft-prosthesis composites, and impaction bone grafting (IBG). IBG has become an accepted technique to treat severe femoral bone loss during complex revision THA procedures. However, the procedure of IBG of the femur is recognized as technically demanding, and one of the reasons for this is the frequent occurrence of intraoperative periprosthetic femoral fractures. For preventing periprosthetic femoral fracture, we report our experience of two cases in which femoral IBG with locking compression plate (LCP) for revision THA was undertaken.

Case 1: A 77-year old woman underwent THA for hip osteoarthritis 17 years previously.

Case 2: A 61-year old man underwent THA for hip osteoarthritis 10 years previously, and revision surgery of the stem for loosening two years previously.

 In both instances, the femoral shaft was fixed by LCP with cable-wire or ultra-high molecular weight polyethylene before removal of the stem. A stem with cement was fixed using the IBG method. There was no fracture, infection or subsidence in either case.

Conclusion: Our results indicate that our method could be a potential solution to use femoral IBG with LCP for maintaining bone stock and preventing intraoperative periprosthetic fracture.