Loss of Bone Stock

Abstract

The problems of diminishing return apply to revision surgery very aptly. On the one hand is the inability to eradicate infection with various antibiotic combinations, while on the other is the ever diminishing bone stock for component fixation. Although pseudarthrosis still is, and must be accepted as, the inevitable outcome in some cases, every effort must be made to preserve or even increase the bone stock. In order to preserve bone stock, revisions need to be timely, while efforts to improve the bone stock may be made at the time of surgery. It is correct to say that at this stage the author’s experience with bone grafting in revision surgery is rather limited, for several reasons. Revisions are undertaken early whenever possible. On the acetabular side the concept of “rim support” for the socket has been actively pursued for a number of years, with some success. On the femoral side excavation of the lesser trochanter for stem support postero-medially has been carried out routinely in revisions. It is the loss of bone stock beyond the level of the lesser trochanter that demands alternative stem designs and methods of support.