Revision total hip arthroplasty. The use of solid allograft.
Intact solid allograft was used to augment severe bone loss in 8 acetabula and 15 femora in 22 patients who underwent revision total hip arthroplasty with noncemented implants. The average follow-up period was 4 years. The average time to radiographic union of whole acetabular allografts was 11 months. Superior migration of the allografts occurred in four patients. Varus tilt of the acetabular component within the allografts was noted in three patients. Eleven patients underwent entire proximal femoral allograft reconstruction, and four patients had femoral head allograft reconstruction. Nine patients with entire proximal femoral allografts achieved radiographic union at an average of 13 months and two failed by nonunion. Only one of the four patients with femoral head allograft reconstruction achieved union. Femoral component subsidence was noted in seven whole proximal femoral allografts (64%). Entire proximal femoral allograft reconstruction was complicated by at least one episode of postoperative dislocation in 6 of 11 procedures. The authors recommend that femoral head allografts should be used with caution to reconstruct proximal femoral deficiencies in which structural support is required for stability of the implant. Successful use of acetabular allografts requires that the majority of the allograft be contiguous to host bone and not to soft tissue. With entire proximal femoral reconstruction, the tip of the femoral component should not reside at the host-graft junction. All components should be cemented into allograft bone; and revision surgery should be performed before osteolytic destruction of bone advances to the point where allograft reconstruction is required.
Zmolek
J C
JC
Sansum Medical Clinic, Santa Barbara, California.
Dorr
L D
LD
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000637:transplantation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000000981:diagnostic imaging / Q000379:methods; D005269:Femur / Q000000981:diagnostic imaging / Q000637:transplantation; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D016896:Treatment Outcome