Impaction bone grafting for femoral revision hip arthroplasty with Exeter Universal stem in Japan

The purpose of the present study was to analyze the retrospective clinical and radiographic results of femoral revision arthroplasties with impaction bone grafting performed by experienced Japanese surgeons.

We investigated the radiographic and clinical records more than 2 years after the surgery in 99 hips of 93 patients. The average age was 66.3 years (36-84 years) and the average follow-up period was 5.2 years (2-13 years). The Merle d'Aubigné and Postel hip score was used for clinical assessment, and peri-operative fractures were recorded. The survival curve was estimated using Kaplan-Meier method.

The mean Merle d'Aubigné and Postel hip score improved from 9.0 points to 15.2 points at the final follow-up. Augmentations for segmental defect of femoral cortices were undertaken in 55 hips. Metal or strut allograft plates were applied to 9 hips and 21 hips, respectively. Intra-operative fractures or perforations occurred in 20 hips. Re-operations of the femur were undertaken in nine hips including five post-operative femoral fractures. More than 5 mm of subsidence was observed in only 2 hips. The survival rates at 8 years after the operation were 94.8 % with femoral fractures as the end point, 93.1 % with any stem removal or exchange as the end point, and 99.0 % with aseptic stem loosening as the end point, respectively.

The present study showed encouraging mid-term results of impaction bone grafting for femoral revision arthroplasty by experienced surgeons in Japan. Aggressive augmentation of segmental defects and attenuated femoral shafts prevents massive stem subsidence and periprosthetic fracture.