Impaction bone grafting in revision hip surgery: past, present and future
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Impaction bone grafting in revision hip surgery: past, present and future Iain R. McNamara
Received: 22 April 2009 / Accepted: 10 July 2009 Springer Science+Business Media B.V. 2009
Abstract Joint replacement surgery can have excellent clinical results. However, as the number of patients undergoing surgery increases, the number of failed joint replacements is set to rise. One of the greatest challenges for the revision surgeon is the restoration of bone stock. This article focuses upon revision hip surgery, with particular reference to the scope of the problem; historical and current solutions to bone loss in the femur and acetabulum; the clinical results following revision surgery; and the basic science behind impaction bone grafting, before ending with possible future directions for improving the restoration of bone stock.
of bone stock after failed joint replacements, or severe bone loss before primary joint replacement. The aim of this article is to review the key concepts behind the use of bone allograft for revision hip surgery. The current and predicted demand for revision surgery will be highlighted, the development of the current surgical technique and the use of allograft bone will be discussed, with particular emphasis on the basic science and clinical evidence behind impaction bone grafting. Finally, an opinion on the future of the use of allograft and alternatives, such as augmentation by stem cells, will be provided with particular reference to revision joint replacement.
Keywords Impaction bone grafting Hip Revision Surgery
Background
Introduction While the first report of a successful bone graft can be traced back to 1668 (Van Meerkeren 1668) it was not until the end of the 19th and beginning of the 20th Century that the applications of bone grafting began to be explored. The use of bone grafting within orthopaedic surgery became more widely applied when surgeons began to face the problems of patients’ loss I. R. McNamara (&) Orthopaedic Research Unit, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 2QQ, UK e-mail: [email protected]
At present over 60,000 total knee replacements and 65,000 total hip replacements are undertaken each year in the UK. When considered in conjunction with the USA, the total number of joint replacements exceed 500,000 per year (Kurtz et al. 2007). Although historically joint replacement surgery was reserved for patients who were elderly, with advanced arthritis and who post operatively placed low demands upon their prosthesis, this has changed. At present 15% of the UK population are over the age of 65 and this percentage will continue to rise (NAO 2008). People are not only living longer and experiencing better quality of life through middle and into old age, but are unwilling to endure the pain and disability of arthritis.
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As such, orthopaedic surgeons are operating upon younger patients who tend to have better health and a longer life expectancy. The net result of all these factors is that the demand for primary total hip an
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