[Femoral reconstruction with massive allograft implanted in a split femur. Mid-term results of 18 reconstructions].
OBJECTIVE
Extensive loss of femoral bone subsequent to implant loosening raises an unsolved problem. The purpose of this work was to examine mid-term results of 18 iterative total hip arthroplasties with femoral reconstruction using massive allografts performed between 1986 and 1997.


METHODS
Using the Vives classification, the femoral bone lesions were grade 3 (n =2) and grade 4 (n =16). The reconstruction was achieved with radiated massive allografts measuring 11 to 35 cm implanted in a split host femur. Charnley-Kerboull implants with a long stem were cemented in the reconstructed femurs.


RESULTS
Mean follow-up was 4 years 10 months (range 2 to 9 years). Nine complications in 7 hips were observed: 6 trochanter nonunions, two recurrent prosthesis dislocations and 1 femoral fracture. At last follow-up, the functional result was excellent or very good in 12 hips (Merle d'Aubigné classification). A stable fixation persisted for 15 implants and 3 had loosened. Graft-host femur consolidation was achieved in all cases except 1. There were 3 cases with extensive resorption of the graft including 2 associated with loosening of the femoral component.


CONCLUSIONS
Reconstruction of the femur after extensive bone loss using a massive allograft appears to be a useful method for restoring bone tissue and providing immediate mechanical support for the femur.
Charrois
O
O
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27, rue du Faubourg-St-Jacques, 75014 Paris. charrois@club-internet.fr
Kerboull
L
L
Vastel
L
L
Courpied
J P
JP
Kerboull
M
M
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D016025:Bone Transplantation; D005260:Female; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D013997:Time Factors; D014184:Transplantation, Homologous