Comparison of femoral head penetration rates between cementless acetabular components with 22-mm and 28-mm heads.

Between April 1993 and July 1994, the senior author (R.C.J.) performed 151 consecutive primary total hip arthroplasties using a Harris-Galante II acetabular component and a polished Iowa femoral component. In 105 hips, 22-mm head components were used, and in 46 hips, 28-mm head components were used. Femoral head penetration into the acetabular shell was measured using digital edge detection techniques. The group average penetration for the initial 2-year bedding-in period was 0.35 mm/y for the 22-mm and 0.31 mm/y for the 28-mm head components. The long-term rate of penetration into the shell was 0.11 mm/y for the 22-mm heads and 0.17 mm/y for the 28-mm heads, a significant difference (P=.029). The dislocation rate was significantly higher, however, with the 22-mm heads (P=.001). The 22-mm components showed significantly less wear but at the expense of an increase in the prevalence of dislocation.

Impaction allografting with cement for extensive femoral bone loss in revision hip surgery: a 4- to 8-year follow-up study.

The current study evaluates the 4- to 8-year results of 26 cemented femoral revisions with impaction allografting using a collared femoral component in cases of extensive femoral bone loss. Patients were followed prospectively and were evaluated at an average of 6.0 years after the allograft revision procedure. The average age at the time of surgery was 69.3 years. At final follow-up, 20 patients (20 hips) were living, and 6 patients (6 hips) were deceased. No femoral component rerevisions were performed for any reason in any patient, and none were radiographically loose at final follow-up. There was 1 subsided femoral component of <5 mm, 3 postoperative periprosthetic femoral fractures, and a greater trochanter nonunion rate of 32%. At the current follow-up interval, these cemented femoral revisions with impaction allografting have performed well with excellent clinical and radiographic durability in this difficult patient population. The prevalence of periprosthetic fracture is a significant concern. This study shows durable results using the impaction allografting technique in cases of severe bone loss.