Experience of structural onlay allografts for the treatment of bone deficiency in revision total hip arthroplasty.
OBJECTIVE
Loss of femoral bone stock in elective revision total hip arthroplasty poses unique and substantial challenges. Structural onlay allografts may provide mechanical stability for the cementless revision prosthesis and increase bone stock.


METHODS
At least one cortical onlay allograft was used in 40 elective total hip arthroplasty revisions (40 patients) to reconstruct femoral bone defects. The operations were performed between January 1999 and August 2010 in the Turku University Hospital, Finland. The mean follow-up time was 52 months (range: 12-125 months).


RESULTS
The allografts were incorporated into the bone tissue in 37 of 40 (92.5%) patients. Cementless revision stems healed in 36 of 40 (90.0%) patients, but these patients were not exactly the same patients whose allografts were successfully incorporated. One or more surgical complications were experienced by 14 of 40 (35.0%) patients during follow-up. In all, 4 of 40 (10.0%) patients (all women) had hip infections during follow-up. Of the 7 patients with rheumatoid arthritis, 4 (57.1%) had at least one complication.


CONCLUSIONS
The use of the cortical onlay allografts provides a feasible option for restoring the integrity of the proximal femur in revision total hip arthroplasty, but the complication rate is high, particularly in female patients with rheumatoid arthritis.
Department of Orthopaedics and Traumatology, Surgical Hospital, Turku University Hospital, Turku, Finland.
J
J
Mokka
H
H
Keemu
M
M
Koivisto
T
T
Stormi
T
T
Vahlberg
P
P
Virolainen
M
M
Junnila
M
M
Seppänen
K T
KT
Mäkelä
D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts / Q000637:transplantation*; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery / Q000637:transplantation*; D005271:Femur Head Necrosis / Q000601:surgery; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D013977:Tibia / Q000637:transplantation*; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome
Structural onlay allograft; bone stock deficiency; infection; loosening; perioperative periprosthetic fracture; revision total hip arthroplasty