Allogenicfemoral defectbone augmentationgraft for ain casehip revisionseries arthroplasty

Abstract

Cortical bone loss in revision hip arthroplasty requires an adequate stabilization to achieve a durable implant fixation. This case series shall illustrate possible indications for the use of allogenic grafts in revision hip arthroplasty. Twelve patients with femoral bone loss were treated with allografts. In addition to establishedclinical scores, the radiological follow-ups were analyzed for hints of implants loosening and the osteointegration of the allografts. After a mean follow-up of 3.0 years the mHHS was 61.3 points and the UCLA 3.8. One patient showed a non-progressive radi-olucency around the hip implant. The osteointegration of all allogenic grafts hap-pened on time. Up to the last follow-up no revision surgery of the hip implants and the associated femoral bone graft was observed. Allogenic bone grafts present a method for biological stabilization in situations of large femoral cortical bone defects in revision hip arthroplasty.for compensation, e.g. autogenous/allogen bone (impaction grafting) with or without combination of revision cups, tantalum augmentation or individual implants.4,5 The number of treatment options for femoral defects are lower. In general, for the first revision of a primary femoral stem a longer revision stem may be used to compensate the loss of spongiosa due to explantation in order to gain good primary stability. An additional option may be to use a modular implant that fills the further cancellous bony defects of the metaphysis as accurate-ly as possible.5 Extensive femoral spongiosa bone loss can also be filled with auto-genous / allogenic bone or compensate with cemented implants. For combined cortical and cancellous defects implants with a dia-physeal fixation are used or a proximal femur replacement up to a megaprosthesis (e.g. total femur) are implanted.6 However, isolated cortical defects or periprosthetic fractures still represent a challenge due to limited treatment options. The aim of surgery is to stabilize and bridge the insuffi-cient bone area with an osteosynthesis plate and cerclages.7 For cortical defects the useof an allogenic bone grafting combined with a long revision implant seems to represent an useful stabilization of insufficientbone conditions of the femur. The aim of this study was to review cases with the use of strut grafts in revision hip arthroplasty. This analysis shall illustrate possible indications for the use of this technique. Along with that, clinical and radiological outcomes in terms of resorp-tion and osseointegration were analyzed. Thus, the survival rate of allogenic femoral bone grafts and further revision treatments were determined.