Introduction: The purpose of this study was to evaluate the long-term clinical and radiological outcome of instrumented femoral revisions after failed total hip arthroplasties using the impaction bone grafting technique with morsellized bone chips in combination with a cemented polished stem.

Methods: Thirty-three consecutive femoral reconstructions were performed between November 1991 and February 1996 using the X-Change femoral impaction system with fresh frozen morsellized bone grafts and a cemented polished Exeter stem. All patients were prospectively followed. The learning curve with this new technique is included in this report. This technique was used in twenty-four women and nine men; the average age at surgery was sixty-three years (range 33–82). Femoral bone stock defects were classified according to the Endoklinik classification as grade 1 in three hips, grade 2 in fourteen hips, grade 3 in twelve hips and grade 4 in four hips. At a minimal eight years follow-up no patient was lost to follow-up, but eight patients died (at 0.5, 3.5, 3.5, 7.0, 7.0, 7.5 and 9.0 after reconstruction). All were followed until death, none of these deaths was related to the surgery, and none had a re-revision

Results: No femoral reconstruction was re-rerevised at a mean follow-up of 10.4 years (range 8 to 13 years). However, there were three femoral fractures during follow-up (at 3, 6 and 22 months), all at the level of tip of the prostheses. All healed after plating, all femoral implants were left in situ. The average Harris hip score improved from 49 prior to surgery to 85 at review (68–100). The average migration of the stem within the cement mantle was three mm (0–14 mm), most migration was seen in the first year. Radiologically, there were no failures. With an endpoint of femoral revision for any reason, with endpoint aseptic loosening or with endpoint radiological loosening the survival rate using the Kaplan-Meier analysis was hundred per cent in all situations (one-sided 95% C.I. 100–91.3 %)

Conclusions Femoral revision using bone impaction grafting with fresh frozen bone grafts and a cemented polished stem showed an excellent survival at eight to thirteen years follow-up.