Use of Cortical Strut Allograft After Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty

作者：Lim Chin Tat; Amanatullah Derek F; Huddleston James I III; Hwang Katherine L; Maloney William J; Goodman Stuart B^*

来源：Journal of Arthroplasty, 2017, 32(5): 1599-1605.

DOI：10.1016/j.arth.2016.12.002

• total hip arthroplasty
• revision hip arthroplasty
• extended trochanteric osteotomy
• cortical strut allograft
• modular femoral stem

Background: Cortical strut allografts restore bone stock and improve postoperative clinical scores after revision total hip arthroplasty (THA). However, use of a cortical strut allograft is implicated in delayed healing of an extended trochanteric osteotomy (ETO). To date, there are no reports directly comparing ETO with or without cortical strut allografts.
Methods: We reviewed prospectively gathered data on 50 revision THAs performed from 2004-2014 using an ETO. We compared the demographic, radiological, and clinical outcome of patients with (16 hips) and without (34 hips) cortical strut allograft after an ETO.
Results: There were no significant differences in Western Ontario McMaster Universities Osteoarthritis Index or Harris Hip Score between the ETOs with and without a cortical strut allograft. Fifteen of the ETOs (94%) with a cortical strut allograft and 31 of the ETOs (91%) without a cortical strut allograft were in situ at final follow-up (P = 1.000). A higher proportion hips with cortical strut allograft (100%, 16 patients) had preoperative Paprosky grade bone loss more than IIIA compared to those without allograft (29%, 10 patients) (P<.001). There were no differences in femoral stem subsidence (P=.207), alignment (P=.934), or migration of the osteotomized fragment (P=.171). Fourteen of the ETOs (88%) in patients with cortical strut allograft united compared to 34 ETOs (100%) in patients without allograft (P=.095).
Conclusion: Our study shows that the use of cortical strut allograft during revision THA with ETO does not reduce the rate of union, radiological or clinical outcomes.

• 出版日期2017-5