Impaction Bone Grafting in Revision Arthroplasty [ Active ]

PREFACE

With old patients living longer and joint replacement being performed in younger patients, the number of revisions have increased sharply. The main reason for revision is progressive osteolysis caused by wear particles culminating in aseptic loosening. Both implants and surgical technique have improved in response to the complexity and challenge of the problem. There are two major options when reconstructing the hip. The first is long stemmed cementless implants loading the femur distally to avoid the potentially adverse effects of acrylic cement and polymer particles. The second restores bone stock using bone allograft. Impaction bone allografting has become a popular method of reconstructing joints with bone loss.

One wonders how impacted soft cancellous bone chips create a stable construct particularly as reports of stem subsidence and subsequent clinical failure challenge the reliability of the technique. However, teams with an extensive experience of this technique achieve excellent clinical results.

We felt it was necessary to clarify these issues. An expert meeting was held on the initiative of EASMT (European Association of Musculoskeletal Transplantation) and EHS (European Hip Society) during the EFFORT meeting in Rhodes on June 5th, 2002. The major aspects of impaction bone grafting were discussed by clinicians, scientists, engineers, and surgeons.