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Published on: August 13, 2017
Structural allograft as an option for treating infected hip arthroplasty with massive bone loss
Paul T H Lee1, Robert A Clayton, Oleg A Safir
1Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, ON M5G 1X5, Canada.
Insights
Structural allografts are a viable option for addressing massive bone loss in infected hip arthroplasty revisions, showing low reinfection rates and improved functional scores. This approach offers a reasonable solution for complex cases.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Infectious Disease Management
Background:
- Revision hip arthroplasty with significant bone loss presents complex challenges.
- The use of structural allografts to reconstruct bone stock in infected hip arthroplasty is debated.
Purpose of the Study:
- To evaluate the efficacy of bulk structural allografts in treating massive bone loss associated with infected hip arthroplasty.
- Key outcomes assessed include reinfection rates, rerevision rates, graft union, resorption, implant migration, functional scores, and complications.
Main Methods:
- Retrospective review of 27 patients undergoing two-stage revision hip arthroplasty with structural allografts for infected cases.
- Allografts included proximal femoral, acetabular, and cortical strut types, with a mean follow-up of 8.2 years.
Main Results:
- A single reinfection (3.7%) occurred in 27 patients.
- Kaplan-Meier survivorship was 93% at 10 years for rerevision due to aseptic loosening.
- Functional hip scores improved significantly post-surgery, with mild graft resorption noted in most cases.
Conclusions:
- Structural allografts represent a reasonable surgical option for managing massive bone defects in infected hip arthroplasty revisions.
- The study supports the use of allografts despite potential complications like nonunion and resorption.
Background:
Revision of the infected hip arthroplasty with major bone loss is difficult. Attempts to restore bone stock with structural allograft are controversial.
Questions/Purposes:
We assessed the (1) reinfection rate; (2) rerevision rate; (3) radiographic graft union, resorption, and implant migration; (4) Harris hip scores at 1 year and at last followup compared with before surgery; and (5) other major complications associated with the use of bulk structural allograft to treat massive bone loss in infected hip arthroplasty.
Methods:
We retrospectively reviewed 27 patients who underwent two-stage revision arthroplasty using structural allograft to treat massive bone defects in infected hip arthroplasty. There were 17 proximal femoral grafts, three acetabular major column grafts, two acetabular minor column grafts, and 10 cortical strut grafts used. Five patients had combinations of two allografts. The minimum followup was 1.1 years (mean, 8.2 years; range, 1.1-16.8 years).
Results:
One of 27 patients had reinfection. The Kaplan-Meier survivorship was 93% at 10 years with rerevision for aseptic loosening as the end point. Radiographically, three patients had nonunion at the graft-host junction. All patients except two had graft resorption, of which all were mild except two, which were severe. Three patients had implant migration. The mean modified Harris hip scores were 39.2 points (range, 25-60) preoperatively, 67.3 points (range, 40-91) at 1-year followup, and 70.3 points (range, 46-81) at last followup. Other major complications included one patient with dislocation and one patient with transient sciatic nerve injury.
Conclusions:
Based on our data, we believe the use of structural allografts is a reasonable option for treating massive bone loss in infected hip arthroplasties.
Level Of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
