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Structural Allograft as an Option for Treating Infected Hip Arthroplasty with Massive Bone Loss

  • Symposium: Periprosthetic Joint Infection
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

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Acknowledgment

We thank Mathew MacDonald for help with data processing.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, ON, M5G 1X5, Canada

    Paul T. H. Lee MB BCh, MA, FRCS (Eng), FRCS (Tr & Orth), Robert A. Clayton MBBS, FRCS (Edin), FRCS (Tr & Orth), Oleg A. Safir MD, FRCSC, MEd, David J. Backstein MD, FRCSC, MEd & Allan E. Gross MD, FRCSC, OOnt

Authors
  1. Paul T. H. Lee MB BCh, MA, FRCS (Eng), FRCS (Tr & Orth)
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  2. Robert A. Clayton MBBS, FRCS (Edin), FRCS (Tr & Orth)
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  3. Oleg A. Safir MD, FRCSC, MEd
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  4. David J. Backstein MD, FRCSC, MEd
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  5. Allan E. Gross MD, FRCSC, OOnt
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Corresponding author

Correspondence to Allan E. Gross MD, FRCSC, OOnt.

Additional information

One or more of the authors (PTHL) received funding from the Royal College of Surgeons of England, the British Orthopaedic Association, and the John Charnley Trust.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Lee, P.T.H., Clayton, R.A., Safir, O.A. et al. Structural Allograft as an Option for Treating Infected Hip Arthroplasty with Massive Bone Loss. Clin Orthop Relat Res 469, 1016–1023 (2011). https://doi.org/10.1007/s11999-010-1673-1

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  • DOI: https://doi.org/10.1007/s11999-010-1673-1

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