CIRCUMFERENTIAL PROXIMAL FEMORAL ALLOGRAFT IN COMPLEX REVISION HIP ARTHROPLASTY

Abstract

In Sheffield the senior author has a long experience in the use of massive circumferential proximal femoral allografts in complex revision hip arthroplasty. Sheffield has a well established bone harvesting and banking service, essential for this type of work.

We wish to present the early experience with this technique in the UK.

Between April 1992 and November 1998 a total of 33 circumferential proximal femoral allografts were used by one senior surgeon. They were all fresh frozen, cadaveric grafts. This time period was selected to allow a reasonable minimum follow-up period. Seven patients had died and two were lost to follow up, leaving a total of 24 patients to review.

A step cut osteotomy was utilised and augmented with a cerclage wire and strut allograft where deemed necessary. The proximal femur was retained where possible. The component was cemented into the allograft only, in the majority of the cases. A cemented, collared prosthesis was used in over 85% of cases.

Average follow up was 53 months. By the time of review 2 had undergone further revision, one for sepsis, one for aseptic loosening. A further patient had had revision of the acetabular component in isolation. One patient had recurrent sepsis but is currently being managed non–operatively. One patient required secondary surgery with plate and graft for symptomatic junctional non-union.

Other complications included wound drainage, delaying discharge, in three patients and one chronic sciatic nerve palsy.

The trochanter was considered radiologically united in 18 patients. Junctional union was considered to have occurred in 17 patients. Allograft resorption of 100% cortical thickness was seen in only 9 patients and in only one zone in 6 of these.

Oxford hip scores were collected at follow-up.

We recommend this technique in cases where bone loss is catastrophic and in specialist hands only.