Femoral reconstruction by massive allografts in revision of hip prostheses with major bone defects

Abstract

Major bone defects are commonly encountered in revision of total hip arthroplasties. We reconstruct both the acetabular and femoral component with bone allografts to allow successful implantation of a new prosthesis. Frozen femoral heads are used for all kinds of acetabular defects and for small femoral defects, and irradiated massive cortical allografts have been used since 1985 for major deficiencies of the femur. The femoral reconstruction technique differed according to the type of surgery: —After removal of a failed massive femoral prosthesis, a long-stem Charnley prosthesis was cemented in the proximal allograft and the distal host femoral shaft. —When revision of standard arthroplasties was performed, different surgical procedures were used according to the type of bone deficiency encountered, the goal being to preserve as much host bone as possible. We used either segmental allografts covered with the remaining host femoral cortex preserved with its soft tissue attachments, or segmental allografts impacted into an enlarged residual shaft. In other cases, a semi-circular allograft strut was used for replacing or reinforcing a deficient cortex. A cemented longstem Charnley prosthesis was generally used, but whenever possible a standard stem was implanted.