ANATOMIC-SPECIFIC PROXIMAL FEMORAL ALLOGRAFTS FOR BONE STOCK RECONSTRUCTION IN REVISION HIP ARTHROPLASTY

Abstract

We have followed a consecutive series of forty-nine revision hip arthroplasties (45 patients), performed for severe femoral bone loss using anatomic specific proximal femoral allografts longer than five centimetres. The patients were followed for a mean of 10.4 years, with a five year minimum follow-up. The mean preoperative Harris Hip Score improved from 42.9 points to 76.9 points postoperatively, an average improvement of 33.8 points. Six hips were further revised, for a failure rate of 12.2%, four for non-union and aseptic failure of the implant (8.2%), one for infection (2%), and one for host step-cut fracture (2%). Junctional union was observed in 44 hips (89.8%). Three hips underwent re-attachment of the greater trochanter for trochanteric escape (6.1%). Asymptomatic non-union of the greater trochanter were noticed in three hips (6.1%). Moderate allograft resorption was observed in five hips (10.2%), non were full-thickness graft resorption. Two fractures of the host step-cut occurred (4.1%). There were four dislocations (8.2%), two of them developed in conjunction with trochanteric escape. By definition of success as increase of HHS by 20 points or more, and no need for any subsequent re-operation related to the allograft and/or the implant, a 75.5% rate of success was found. Kaplan-Meier survivorship analysis predicted 73% rate of survival at 12 years, with the need for further revision of the allograft and/or implant as the end point. We conclude that the good medium-term results with the use of large anatomic-specific femoral allografts justify their continued use in cases of revision hip arthroplasty with severe bone stock loss.