Background:
The use of impacted morselized allograft bone and cement in hip
revision arthroplasty has been popular, but studies that specifically
address intraoperative and postoperative complications have been
scarce.
Methods:
All complications that occurred during, and within the first year
after, 144 consecutive hip revision arthroplasties (108 stems and
130 sockets) performed with impacted morselized allograft bone and
cement were recorded. Clinical and radiographic follow-up evaluation
was performed at three months and at one year after surgery for
all patients except eight (seven who had died of causes unrelated
to the hip surgery and one who had sustained a stroke). Of these
eight patients, seven had a six-week and/or three-month follow-up
evaluation.
Results:
Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine
of the fractures occurred during surgery and ten, within five months
after surgery. Of the intraoperative femoral fractures, twelve were
proximal, nine were diaphyseal, and eight involved the greater trochanter.
Of the postoperative femoral fractures, one was proximal and nine
were diaphyseal. Other intraoperative complications were the creation
of a femoral cortical window in seven hips and incidental perforation
of the femoral cortex in fourteen. Multivariate analysis showed
the risk factors for femoral fracture during or after revision to
be concomitant disease, greater deficiency of the femoral bone stock,
and an intraoperative femoral window or perforation. Other complications
included dislocation of the femoral head in nine hips, deep infection
in one hip, persistence of preoperative deep infection in one hip,
and superficial wound infection requiring wound d�bridement in two hips.
Conclusions:
We found the complication rate to be high after hip revision arthroplasty
performed with impacted morselized allograft bone and cement. The
most serious complication was postoperative diaphyseal femoral fracture.