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Published on: May 25, 2012
Femoral impaction bone grafting with the Elite Plus stem
D E Robinson1, M B Lee, V A Smith
1Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol - UK.
Insights
Impaction grafting using the Elite Plus system for revision hip arthroplasty showed a high failure rate, particularly in patients with significant bone loss. Graft incorporation was limited, with poor bone remodeling observed in this study.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Revision hip arthroplasty is complex, often requiring bone reconstruction.
- Impaction grafting with allograft is a technique used to address bone stock defects.
- The Elite Plus system is one option for femoral stem implantation in revision cases.
Purpose of the Study:
- To evaluate the outcomes of impaction grafting with the Elite Plus femoral stem.
- To assess graft incorporation and bone healing after revision hip arthroplasty.
- To determine the failure rate and complications associated with this technique.
Main Methods:
- A prospective study of 19 hips undergoing revision hip arthroplasty.
- Utilized the Elite Plus femoral stem with irradiated allograft for impaction grafting.
- Patients were followed for an average of 33 months with radiographic and clinical assessments.
- Bone stock loss was graded using the Endo-Klinik classification.
Main Results:
- Graft incorporation was observed in 32% of cases.
- No significant trabecular remodeling or cortical repair was evident radiographically.
- A high failure rate was noted, with 4 patients requiring revision surgery.
- Complications were more frequent in patients with Endo-Klinik grade 3 bone loss.
Conclusions:
- Impaction grafting with the Elite Plus system demonstrated a high failure rate in revision hip arthroplasty.
- The technique appears less successful in patients with substantial bone stock loss.
- Further research is needed to improve outcomes for complex revision hip surgeries.
Abstract:
This study evaluates the results of impaction grafting of the femoral stem with the Elite Plus system (DePuy, Leeds, UK) in revision hip arthroplasty with irradiated allograft. Nineteen hips in 19 patients (12 men and 7 women), at an average age of 59 years were followed for an average of 33 months. Endo-Klinik grading of bone stock loss was 5 grade 1, 6 grade 2, 8 grade 3 and no grade 4. Radiographic analysis revealed evidence of graft incorporation in 32% but no evidence of trabecular remodelling or cortical repair. Four patients have undergone revision of the femoral stem, one patient died while awaiting revision and one patient is unfit for revision. Most complications occurred in patients classified as Endo-Klinik grade 3. We found that impaction grafting with the Elite Plus system was associated with a high failure rate, especially in those cases with more severe bone stock loss. (Hip International 2002; 1: 11-6).
