Variables Affecting Initial Stability of Impaction Grafting for Hip Revision.
Gokhale, Satish FRCS ORTH *; Soliman, Ayman MSCORTH +++; Dantas, Joao Pedro MD [S]; Richardson, James Bruce MD +[//]; Cook, Frank BSC [//]; Kuiper, Jan-Herman PHD +[//]; Jones, Peter PHD [P]
[Article] Clinical Orthopaedics & Related Research. 432:174-180, March 2005.

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Impaction grafting allows restoration of bone stock in hip revision, but there are reports of massive early subsidence. The aim of this study was to determine prognostic factors for stem and cup migration in a group of 56 consecutive patients followed up from 1 to 5 years. Cup and stem migration was correlated with 13 predictors including stem design, stem positioning, femoral anatomy, patient characteristics, and bone graft density. All migration occurred mainly during the first 3 months after surgery. Stem alignment changed by an average of 4.8[degrees]. Fifty percent of the change in stem alignment was explained by four variables: age, femoral diameter, stem design, and density of the graft at the tip of the stem. Stem subsidence averaged 2.7 mm, and cup migration averaged 3.0 mm. None of the predictors explained the wide variation of migration of the cup or distal migration of the stem. It may be necessary to determine implant stability at the time of surgery.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

(C) 2005 Lippincott Williams & Wilkins LWW