Proximal femoral bone defects reconstructed with calcar metal mesh, impacted bone allografts, and cemented stem in revision hip surgery

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Martin Buttaro
Vicente Gozalbes
Fernando Comba
Gerardo Zanotti
Francisco Piccaluga

Abstract

BackgroundOne of the essential requisites for the impaction grafting method is containment of the impacted cancellous bone within the medullary cavity. In patients with segmental bone loss, this procedure can be performed with metal mesh on the outside of the femur. Although the combination between metal meshes and impacted bone allografts is commonly used clinically, data in literature is lacking. Objective: To analyse the results in cases with proximal femoral bone defects reconstructed with a calcar metal mesh, impacted bone allografts, and a cemented stem in revision hip surgery.MethodsWe prospectively followed 91 cases with proximal femoral bone defects reconstructed between 2002 and 2006 with a calcar metal mesh, impacted bone allografts, and a cemented stem. Patients’ average age was 66 years (range, 32-88 years); there 64 females and 27 males. Femoral deficiencies were classified according to the Endoklinik: 50 cases presented a grade 3 defect, 38 cases presented a grade 4 defect and 2 cases a grade 1. We implanted 44 short conventional stems and 47 long stems. Results: Reconstruction survival was 98% after a minimum follow-up of 31 months and a maximum of 87 months. We observed one fracture of the metal mesh and femoral long stem that was reoperated and a traumatic asymptomatic fracture of the metal mesh that did not require surgery 1.5 years after this episode. 97 Average stem subsidence was 3.6 mm. We observed 8 dislocations (9%), 7 infections (8%) and 2 periprosthetic fractures. Conclusions: Although the incidence of complications in these patients was high, this could be related to the complexity of the cases. Mesh failures were not observed except in the two cases presenting massive femoral bone loss and trauma. Patients with calcar femoral defects may be candidates for biological femoral reconstructions using metal mesh, impacted bone allografts and a cemented stem.

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How to Cite
Buttaro, M., Gozalbes, V., Comba, F., Zanotti, G., & Piccaluga, F. (2012). Proximal femoral bone defects reconstructed with calcar metal mesh, impacted bone allografts, and cemented stem in revision hip surgery. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 77(2), 96-103. https://doi.org/10.15417/48
Section
Clinical Research
Author Biography

Martin Buttaro

Medico de planta, Centro de Cadera "Sir John Charnley"Servicio de Ortopedia y Traumatología "Carlos E. Ottolenghi"Hospital Italiano de Buenos Aires

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