Article

Proximal femoral allografts for reconstruction of bone stock in revision arthroplasty of the hip.

Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 11/1995; DOI: 10.1097/00003086-199510000-00015
Source: PubMed

ABSTRACT Proximal femoral allografts have been used to restore uncontained circumferential defects of the multiply revised total hip arthroplasty. These grafts are used with long stem components that are cemented to the graft but not the host. The junction of host and graft is stabilized by the stem and a step cut with cerclage wires. Autograft bone is placed at the junctions to induce union. Full weightbearing is delayed until union occurs between the graft and the host femur, usually by 3 months. One hundred sixty-eight structural femoral allografts were done; average followup was 4.8 years as of January 1, 1995. Success was defined as an increase in the clinical score of at least 20 points, a stable implant, and no need for further surgery related to the allograft. The success rate in 130 patients with at least 2 years followup is 85%. There have been 17 revisions in 16 patients: 3 revisions for infection, 8 for dislocation, 5 for nonunion, and 1 for pain. The revision rate is 10.1%. Radiographic analysis showed 7 nonunions, minor resorption in 6 patients, and significant resorption in 1 patient. All implants are stable with no lucent lines. The results support using this technique for full circumferential segmental proximal femoral defects in revision hip arthroplasty.

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    ABSTRACT: Musculoskeletal allografts have a defi-nite role in reconstructive surgery of the lower extremity. Although this role has been controversial in the past, the use of allografts is now clearly indicated. In addition, the improved safety and avail-ability of banked tissue has made its use more universal. The purposes of the cur-rent paper are to describe the role of al-lografts in revision hip arthroplasty and to outline the indications, surgical tech-niques, and results at our institution. Revision Arthroplasty of the Hip Restoration of bone stock is an impor-tant goal in revision arthroplasty of the hip, particularly for patients who may need additional surgery in the future 1 . In some patients, the bone loss may be so severe that without restoring bone stock it is not possible to stabilize a new implant even when it is one designed to be used after tumor excision. A tumor prosthesis can be used in some revision situations; however, these megaprosthe-ses generally are more appropriate after en bloc excision of bone tumors be-cause the uncertain prognosis necessi-tates faster rehabilitation. Furthermore, chemotherapy and radiation have dele-terious effects on bone grafts 2,3 . These megaprostheses do not restore bone stock, and additional surgery in the future is more difficult because the ce-ment or the implants themselves make revision very difficult. In addition, these implants do not allow biological reat-tachment of tendons to bone 4,5 .
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