Aim. To compare radiological and clinical outcomes between triceps-detaching and triceps-sparing approaches in total elbow arthroplasty, with specific focus on cementing technique and post-operative range of motion. Methods. A retrospective review was completed of medical records and radiographs of 56 consecutively managed patients who underwent a primary total elbow arthroplasty between 2000 and 2012 at a tertiary hospital. Rheumatoid Arthritis was the predominant pathology (47/56). Data analysed included patient demographics, range of motion pre-operatively and at various stages post-operatively, approach utilized, operative time and complications. Cementing technique was graded as adequate, marginal or inadequate according to Morrey's criteria. Results. 12 patients were lost to follow-up or had incomplete records, leaving 44 patients for analysis. 15 patients had a triceps-sparing approach, and 29 had a variation of a triceps-detaching approach. Average follow-up was 56.1 months. Flexion range of motion in the triceps-sparing group improved from 25°–122° (±19.6°) pre-op to 10°–140° (±22.5°) at final follow-up, and in the triceps-detaching group from 41°–104° (± 22.2°) pre-op to 27°–129° (±35.0°) at final follow-up. Tourniquet time averaged 85.4 (±17.0) minutes for the triceps-sparing group and 96.1 (±22.6) minutes for the triceps-detaching group. The complication rate in the triceps-sparing group was 13.3%, and included one olecranon fracture and one case of superficial wound sepsis. The complication rate for the triceps-detaching group was 24.1%, and included one patient with persistent ulnar nerve symptoms requiring transposition, one medial condyle fracture and five triceps ruptures. Three patients who had attempted repairs of the rupture developed deep infections requiring multiple further surgeries. Cementing technique was adequate in 91.7% in the triceps-sparing group and in 70.6% in the triceps-detaching group and marginal in the remainder of the cohort. Conclusion. A triceps-sparing approach results in a predictable improvement in range of motion with no compromise of the cement mantle. NO DISCLOSURES

Introduction

Total Hip Arthroplasty (THA) is currently one of the most widely performed surgical procedures in clinical orthopaedic practice. Despite the recorded number of uncemented implants has steadily increased in recent years, cemented fixation still remains the benchmark in THA, accounting for most of the procedures performed nowadays. The Friendly Short is a novel cemented short-stem that grants a less invasive and more bone conservative approach due to its shortened height and innovative cementing technique. It is indicated to treat elderly patients with the aim of preserving bone diaphysis while decreasing postoperative recovery times. Its instrument set allows to optimize the cement mantle thickness via an improved pressurization and stem centralization system.

Introduction

Aseptic loosening has been reported to be the most common, contemporary mode of total knee arthroplasty failure. It has been suggested that the etiology of revision due to loosening can be attributed, in part, to joint imbalance and the variability inherent in standard surgical techniques. Due to the high prevalence of revision, the purpose of this study was to quantify the change in kinetic loading of the knee joint before versus after the application of the final cement-component complex.

INTRODUCTION

The cement quantity and distribution within femoral hip resurfacings are important for implant survival. Too much cement could cause thermal bone necrosis during polymerisation. Insufficient cement and cement-implant interfacial gaps might favour mechanical loosening. Exposed cancellous bone within the implant, might facilitate debris-induced osteolysis. This study assessed the impact of the cementing technique on the cement mantle quality in hip resurfacing.

Introduction

Hip resurfacing arthroplasty has gained popularity as an alternative for total hip arthroplasty. Usually, cemented fixation is used for the femoral component. However, each type of resurfacing design has its own recommended cementing technique.

In a recent investigation the effect of various cementing techniques on cement mantle properties was studied. This study showed distinct differences in cement mantle volume, filling index and morphology.

In this study, we investigated the effect of these cement mantle variations on the heat generation during polymerization, and its consequences in terms of thermal bone necrosis.

Aim

To undertake a biomechanical study to determine the existence of any difference in the early tibial component fixation to bone, between two widely used techniques of cementation, which may confer an influence on implant survival.

Purpose

The purpose of this study is to compare using a novel cementing technique with hydroxyapatite granules at bone-cement interface with using the 3^rd cementing technique on the acetabular component.

There has been an evolution in revision hip arthroplasty towards cementless reconstruction. Whilst cemented arthroplasty works well in the primary setting, the difficulty with achieving cement fixation in femoral revisions has led to a move towards removal of cement, where it was present, and the use of ingrowth components. These have included proximally loading or, more commonly, distally fixed stems. We have been through various iterations of these, notably with extensively porous coated cobalt chrome stems and recently with taper-fluted titanium stems. As a result of this, cemented stems have become much less popular in the revision setting. Allied to concerns about fixation and longevity of cemented fixation revision, there were also worries in relation to bone cement implantation syndrome when large cement loads were pressurised into the femoral canal at the time of stem cementation. This was particularly the case with longer stems. Technical measures are available to reduce that risk but the fear is nevertheless there. In spite of this direction of travel and these concerns, there is, however, still a role for cemented stems in revision hip arthroplasty. This role is indeed expanding. First and foremost, the use of cement allows for local antibiotic delivery using a variety of drugs both instilled in the cement at the time of manufacture or added by the surgeon when the cement is mixed. This has advantages when dealing with periprosthetic infection. Thus, cement can be used both as interval spacers but also for definitive fixation when dealing with periprosthetic hip infection. The reconstitution of bone stock is always attractive, particularly in younger patients or those with stove pipe canals. This is achieved well using impaction grafting with cement and is another extremely good use of cement. In the very elderly or those in whom proximal femoral resection is needed at the time of revision surgery, distal fixation with cement provides a good solution for immediate weight bearing and does not have the high a risk of fracture seen with large cementless stems. Cement is also useful in cases of proximal femoral deformity or where cement has been used in a primary arthroplasty previously. We have learnt that if the cement is well-fixed then the bond of cement-to-cement is excellent and therefore retention of the cement mantle and recementation into that previous mantle is a great advantage. This avoids the risks of cement removal and allows for much easier fixation. Stems have been designed specifically to allow this cement-in-cement technique. It can be used most readily with polished tapered stems - tap out a stem, gain access at the time of revision surgery and reinsert it. It is, however, now increasingly used when any cemented stems are removed provided that the cement mantle is well fixed. The existing mantle is either wide enough to accommodate the cement-in-cement revision or can be expanded using manual instruments or ultrasonic tools. The cement interface is then dried and a new stem cemented in place. Whilst the direction of travel in revision hip arthroplasty has been towards cementless fixation, particularly with tapered distally fixed designs, the reality is that there is still a role for cement for its properties of immediate fixation, reduced fracture risk, local antibiotic delivery, impaction grafting and cement-in-cement revision

Revision of the humeral component in shoulder arthroplasty is frequently necessary during revision surgery. Newer devices have been developed that allow for easy extraction or conversion at the time of revision preserving bone stock and simplifying the procedure. However, early generation anatomic and reverse humeral stems were frequently cemented into place. Monoblock or fixed collar stems make accessing the canal from above challenging. The cortex of the Humerus is far thinner than the femur and stress shielding has commonly led to osteopenia. Many stem designs have fins that project into the tuberosities putting them at risk for fracture on extraction. Extraction starts with an extended deltopectoral incision from the clavicle to the deltoid insertion. The proximal humerus needs to be freed from adhesions of the deltoid and conjoined tendon. The deltopectoral interval is fully developed. Complete subscapularis and anterior capsular release to the level of the latissimus tendon permits full exposure of the humeral head. After head removal the stem can be assessed for loosening and signs of periprosthetic joint infection. The proximal bone around the fin of the implant should be removed from the canal. If possible, the manufacturer's extractor should be utilised. If not, then a blunt impactor can be placed from below against the collar of the stem to assist in extraction. With luck the stem can be extracted from the cement mantle. If there is no concern for infection, the cement-in-cement technique can be used for revision. Otherwise, attempts should be made to extract all the cement and cement restrictor, if present. The small cement removal tools from the hip set can be used and specialised shoulder tools are available. An ultrasound cement removal device can be very helpful. The surgeon must be particularly careful to avoid perforation of the humeral cortex. This is especially important when near the radial nerve as injury can occur. When a well-fixed stem is encountered, an osteotomy of the proximal humerus is necessary. The surgeon can utilise a linear cut with an oscillating saw along the bicipital groove for the length of the implant. An osteotome is used to crack the cement mantle allowing stem extraction. Alternatively, a window can be created to offer additional access to the cement mantle. In the event the surgeon has required an osteotomy or window, cerclage wires, cables or suture will be needed and when the bone is potentially compromised, allograft bone graft struts (tibial shaft) are used for additional support. Care is needed when passing cerclage wires to avoid injury to the radial nerve which is adjacent to the deltoid insertion. If infection is suspected or confirmed an ALBC spacer is placed. When single stage revision is planned both cemented and uncemented stem options are available. Cement placed around the humeral stem has been suggested to decrease infection incidence. Revision of cemented humeral stems is a continued challenge in revision shoulder surgery. Newer systems and reverse total shoulder options have improved the surgeon's ability to achieve good outcomes when revising prior shoulder arthroplasty

The two-staged exchange for periprosthetic joint infection (PJI) has become the “gold standard” worldwide. Based on the first implementation of mixing antibiotics into bone cement by Prof. Buchholz in the 1970s, the ENDO-Klinik followed a distinct one staged exchange for PJI in over 85 % of all our infected cases until today. Looking carefully at current literature and guidelines for the PJI treatment, there is no clear evidence, that a two-staged procedure has a clearly higher success rate than a one-staged approach. Although postulated in relevant articles, most recommendations, e.g. duration of antibiotics, static vs. mobile spacer, interval of spacer retention, cemented vs. uncemented implant fixation, are based on Level IV to III evidence studies or expert opinions, rather than on prospective randomised or comparative data. Potentially a cemented one-stage exchange offers certain advantages, as mainly based on need for only one operative procedure, reduced antibiotics & hospitalization time and reduced relative overall costs. In order to fulfill a one-staged approach with the above described potential success, there are obligatory pre-, peri- and postoperative details, which need to be meticulously respected. The absolute mandatory infrastructural requirement is based on the clear evidence of the bacteria in combination with a distinct patient specific plan, by an experienced microbiologist, for following topical antibiotics in the bone cement with combined systemic antibiotics. Mandatory preoperative diagnostic testing is based on the joint aspiration with an exact identification of the bacteria. The presence of a positive bacterial culture and respective antibiogramm is essential, to specify the antibiotics loaded into the bone cement, which allows a high topical antibiotic elution directly at the surgical site. A specific treatment plan is generated by a microbiologist. Contraindications for a one-staged exchange include: failure of >2 previous one-staged procedures, infection spreading to the nerve-vessel bundle, unclear preoperative bacteria specification, unavailability of appropriate antibiotics, high antibiotic resistance. The surgical success relies not only on the complete removal of all preexisting hardware material (including cement and restrictors), furthermore an aggressive and complete debridement of any infected soft tissues and bone material is needed. Mixing antibiotics into the cement needs to fulfill the following criteria: Appropriate antibiogramm, adequate elution characteristics, bactericidal (exception clindamycin), powder form (never use liquid AB), maximum addition of 10 %/PMMA powder. Current principles of modern cementing techniques should be applied. Postoperative systemic antibiotic administration is usually followed for only 10–14 days (exception: streptococci). We recommend an early and aggressive mobilization within the first 8 days postoperatively, due to the cemented fixation an immediate mobilization under full weight bearing becomes possible in most cases. Persistence or recurrence of infection remains the most relevant complication in the one-staged technique. As failure rates with a two-staged exchange have been described between 9% and 20% in non-resistant bacteria, the ENDO-Klinik data shows comparative results after 8–10 years of follow up. In summary a cemented one-stage exchange offers various advantages. Mainly the need for only one operation, shorter hospitalization, reduced systemic antibiotics, lower overall cost and relative high patient satisfaction. However, a well-defined preoperative planning regime including an experienced microbiologist is absolutely mandatory

Background. Cemented femoral stems have an excellent long-term outcome. Modern cement techniques should be used to optimize femoral stem fixation. Bleeding from the bone surface during cemented hip arthroplasty compromises the bone-cement interface. However, no studies have examined this bleeding in vivo nor the effect the different cleaning methods used. In the present study we evaluated bleeding patterns and efficacy of cleaning methods used in third generation cementing techniques. Methods. We prospectively performed a medulloscopy with a 10 mm laparoscope in 200 primary hip arthroplasties. Intramedullary bleeding was evaluated after femoral canal preparation and use of the different cleaning methods. The femoral canal was divided into three areas to facilitate comparison. The intramedullary bleeding was standardized on a four point scale. A non-parametric repeated measures ANOVA was used for statistical analysis. Results. Cotton swabs and brushes did not reduce the intramedullary bleeding significantly after broaching of the canal. Compared to these standard cleaning methods, pulsed lavage and the addition of brushing provided better blood removal (p<0.001). There was a trend, although not statistical significant (p=0.24), towards better canal cleaning if a canal filling tampon with suction was added. Arterial bleeding originating from the posterior wall of the canal was noticed in 26 cases (13 percent). These could only be controlled by diathermy tools. Conclusion. Most standard preparation techniques are insufficient to prepare the femoral canal before cement insertion. In case of severe intramedullary bleeding, an arterial bleeding should be ruled out and if necessary treated with the aid of diathermy tools. We recommend pulsed lavage combined with a brush and a canal filling tampon for femoral canal preparation in cemented primary hip arthroplasty for optimal reduction of intramedullary bleeding

Starting in 1977 a new cemented stem made of titanium alloy (with vanadium) was designed regarding some principle: rectangular shape, smooth surface covered with thin layer of titanium oxide, filling the medullar cavity. As a consequence: a thin layer of cement. It was designed with a collar. Initial Cementing technique used dough cement, vent tube and finger packing; then we applied cement retractor low viscosity cement and sometimes Harris Syringe. At the moment we went back to initial technique plus a cement retractor made of polyethylene. Many papers looked at long term follow up results depicting about 98 to 100 percent survivors at 10 years and 95 to 98% at 20 years (Hernigou, Hamadouche, Nizard, El Kaim). Clinical as well as radiological results are available. Radiological results depicted some radiolucent lines that appeared at the very long term. They could be related to friction between the stem and the cement. As advocated by Robin Ling, he called “French paradox” the fact that if a cemented prosthesis is smooth and fills the medullary cavity, long term excellent results could be expected. This was the case with stainless steel Kerboull shape, the Ling design (Exeter)and the Ceraver design. The majority of these stems were implanted with an all alumina bearing system. And in some occasion, when revision had to be performed, the stem was left in place (108 cases over 132 revisions). Our experience over more than 5000 stems implanted is outstanding (see figure 1: aspect after 30 years). Discussion other experience with cemented titanium stem were bad (Sarmiento, Fare). We suspect that this was related either to the small size of this flexible material, or to the roughness of its surface. If one uses titanium cemented stem it must be large enough and extra smooth

The two-staged exchange for periprosthetic joint infection (PJI) has become the “gold standard” worldwide. Based on the first implementation of mixing antibiotics into bone cement by Prof. Buchholz in the 70's, the ENDO-Klinik followed a distinct one-staged exchange for PJI in over 85% of all our infected cases until today. Looking carefully at current literature and guidelines for the PJI treatment, there is no clear evidence, that a two-staged procedure has a clearly higher success rate than a one-staged approach. Although postulated in relevant articles, most recommendations, e.g. duration of antibiotics, static vs. mobile spacer, interval of spacer retention, cemented vs. uncemented implant fixation, are based on level IV to III evidence studies or expert opinions, rather than on prospective randomised or comparative data. Potentially a cemented one-stage exchange offers certain advantages, as mainly based on need for only one operative procedure, reduced antibiotics & hospitalization time and reduced relative overall costs. In order to fulfill a one-staged approach with the above described potential success, there are obligatory pre-, peri- and post-operative details, which need to be meticulously respected. The absolute mandatory infrastructural requirement is based on the clear evidence of the bacteria in combination with a distinct patient specific plan, by an experienced microbiologist, for the topical antibiotics in the bone cement with combined systemic antibiotics. Mandatory pre-operative diagnostic testing is based on the joint aspiration with an exact identification of the bacteria. The presence of a positive bacterial culture and respective antibiogramm is essential, to specify the antibiotics loaded to the bone cement, which allows a high topical antibiotic elution directly at the surgical site. A specific treatment plan is generated by a microbiologist. Contraindications for a one-staged exchange include: failure of > 2 previous one-staged procedures, infection spreading to the nerve-vessel bundle, unclear pre-operative bacteria specification, unavailability of appropriate antibiotics, high antibiotic resistance. The surgical success relies not only on the complete removal of all preexisting hardware material (including cement and restrictors), furthermore an aggressive and complete debridement of any infected soft tissues and bone material is needed. Mixing antibiotics to the cement needs to fulfill the following criteria: Appropriate antibiogramm, adequate elusion characteristics, bactericidal (exception clindamycin), powder form (never use liquid AB), maximum addition of 10%/PMMA powder. Current principles of modern cementing techniques should be applied. Post-operative systemic antibiotic administration is usually followed for only 10–14 days (exception: streptococci). We recommend an early and aggressive mobilization within the first 8 days post-operatively due to the cemented fixation an immediate mobilization under full weight bearing becomes possible in most cases. Persistence or recurrence of infection remains the most relevant complication in the one-staged technique. As failures rates with a two-staged exchange have been described between 9% and 20% in non-resistant bacteria, the ENDO-Klinik data shows comparative results after 8–10 years of follow up, which were confirmed independently also by some other international reports and study groups. In summary a cemented one-stage exchange offers various advantages. Mainly the need for only one operation, shorter hospitalization, reduced systemic antibiotics, lower overall cost and relatively high patient satisfaction. However a well-defined pre-operative planning regime including an experienced microbiologist is absolutely mandatory

The two-staged exchange for periprosthetic joint infection (PJI) has become the “gold standard” worldwide. Based on the first implementation of mixing antibiotics into bone cement by Prof. Buchholz in the 70's, the ENDO-Klinik followed a distinct one staged exchange for PJI in over 85% of all our infected cases until today. Looking carefully at current literature and guidelines for the PJI treatment, there is no clear evidence, that a two-staged procedure has a clearly higher success rate than a one-staged approach. Although postulated in relevant articles, most recommendations, e.g. duration of antibiotics, static vs. mobile spacer, interval of spacer retention, cemented vs. uncemented implant fixation, are based on level IV to III evidence studies or expert opinions, rather than on prospective randomised or comparative data. Potentially a cemented one-stage exchange offers certain advantages, as mainly based on need for only one operative procedure, reduced antibiotics & hospitalization time and reduced relative overall costs. In order to fulfill a one-staged approach with the above described potential success, there are obligatory pre-, peri- and post-operative details, which need to be meticulously respected. The absolute mandatory infrastructural requirement is based on the clear evidence of the bacteria in combination with a distinct patient specific plan, by an experienced microbiologist, for following antibiotics in the bone cement with combined systemic antibiotics. Mandatory preoperative diagnostic test is based on the joint aspiration with an exact identification of the bacteria. The presence of a positive bacterial culture and respective antibiogramm is essential, to specify the antibiotics loaded to the bone cement, which allows a high topic antibiotic elution directly at the surgical side. A specific treatment plan is generated by an microbiologist. Contraindications for a one staged exchange include: failure of >2 previous one-staged procedures, infection spreading to the nerve-vessel bundle, unclear preoperative bacteria specification, unavailability of appropriate antibiotics, high antibiotic resistance. The surgical success relies not only on the complete removal of all preexisting hardware material (including cement and restrictors), furthermore an aggressive and complete debridement of any infected soft tissues and bone material is needed. Mixing antibiotics to the cement needs to fulfill the following criteria: Appropriate antibiogramm, adequate elution characteristics, bactericidal (exception clindamycin), powder form (never use liquid AB), maximum addition of 10%/PMMA powder. Current principles of modern cementing techniques should be applied. Postoperative systemic antibiotic administration is usually followed for only 10–14 days (exception: streptococci). We recommend an early and aggressive mobilization within the first 8 days postoperatively, due to the cemented fixation an immediate mobilization under full weight bearing becomes possible in most cases. Persistence or recurrence of infection remains the most relevant complication in the one-staged technique. As failures rates with a two-staged exchange have been described between 9% and 20% in non-resistant bacteria, the ENDO-Klinik data shows comparative results after 8–10 years of follow up, which were confirmed independently also by some other international reports and study groups. In summary a cemented one-stage exchange offers various advantages. Mainly the need for only one operation, shorter hospitalization, reduced systemic antibiotics, lower overall cost and relative high patient satisfaction. However, a well-defined preoperative planning regime including an experienced microbiologist are absolutely mandatory

The two-staged exchange for periprosthetic joint infection (PJI) has become the “gold standard” worldwide. However, based on the first implementation of mixing antibiotics into bone cement by Prof. Buchholz in the 1970s, the ENDO-Klinik followed a distinct one staged exchange for PJI in over 85% of all our infected cases until today. Looking carefully at current literature and guidelines for the PJI treatment, there is no clear evidence, that a two-staged procedure has a clearly higher success rate than a one-staged approach. A cemented one-stage exchange offers certain potential advantages, mainly the need for only one operative procedure resulting in reduced antibiotic administration, hospitalisation time, and relative overall costs. In order to fulfill a one-staged approach which results in the above described potential success, there are obligatory pre-, peri- and post-operative details, which need to be meticulously respected. The absolute mandatory infrastructural requirement is a clear knowledge of the infecting organism in combination with a distinct patient specific plan recommended by an experienced microbiologist, for the local antibiotics in the bone cement and the systemic antibiotics, administered to the patient post-operatively. This requires a mandatory pre-operative diagnostic test based on the joint aspiration with an exact identification of the bacteria. The presence of a positive bacterial culture and respective antibiogramm is essential, to identify the specific antibiotics loaded to the bone cement, which allows a high topic antibiotic elution directly at the surgical side. Contraindications for a one staged exchange include: . Failure of > 2 previous one-staged procedures. Infection spreading to the nerve-vessel bundle, which allows no radical debridement. Unclear pre-operative bacteria specification. Unavailability of appropriate antibiotics due to high antibiotic resistance. The surgical success relies not only on the complete removal of all foreign material (including cement and restrictors), but also on the required aggressive and complete debridement of any infected soft tissues and bone material. The mixing of antibiotics into the cement must fulfill the following criteria: Appropriate antibiogramm, adequate elusion characteristics, bactericidal (exception clindamycin), powder form (never use liquid AB), maximum addition of 10%/PMMA powder. Current principles of modern cementing techniques should be applied. Post-operative systemic antibiotic administration is usually followed for only 10–14 days (exception: streptococci). Persistence or recurrence of infection remains the most relevant complication in the one-staged technique. As failure rates with a two staged exchange have been described between 9% and 20% in non-resistant bacteria, the ENDO-Klinik data shows comparative results after 8 to10 years of follow-up. In summary a cemented one-stage exchange offers various advantages. Mainly the need for only one operation, shorter hospitalisation, reduced systemic antibiotics, lower overall cost and a relatively high patient satisfaction rate. However, a well-defined pre-operative planning regime including an experienced surgeons team and microbiologist are absolutely mandatory for its overall success

Introduction. Segmental defects of the femur present a major problem during revision hip arthroplasty. In particular, calcar segmental defects may compromise initial and long-tem femoral stem stability. Objective. The objective of the present study is to assess mid-term clinical and radiographic follow-up results at least two years after femoral revision comprising reconstruction for calcar segmental defect using metal wire mesh and impacted morcellised allograft. Methods. We performed 26 femoral revisions with calcar reconstruction in 24 patients between 2002 and 2010. The average age was 69.7 years, and the average follow-up period was 5 years and 1 month. All surgeries were performed using a cemented polished collarless tapered stem. The segmental calcar defect was reconstructed with metal wire mesh with doubled stainless wires. Large sized morcellised cancellous allograft was tightly impacted into the cavity between the phantom stem and the metal wire mesh. Nineteen hips were reconstructed with impaction bone grafting of the femur, and 7 hips with cement-in-cement technique except for the reconstructed calcar region.ã�� For clinical assessment, Merle d'Aubigné and Postel hip scores were recorded. For radiological assessment, antero-posterior hip radiographs were analyzed pre-operatively, and post-operatively at one month, 6 months and every 6 months thereafter. Clear lines around the femoral component using Gruen zone classification, stem subsidence in cement mantle, and change of stem axis were recorded. Kaplan-Meier survival analyses were performed with any re-operation of the femoral component or aseptic loosening as end points. In one case, the histological appearance of a biopsy specimen of the most proximal part of the reconstructed calcar, which was obtained at a later surgery for infection at 4 years after the revision, is described. Results. For clinical assessment, the mean Merle d'Aubigné and Postel hip scores improved from 10.4 points before the operation to 14.7 points at the final follow-up. For radiological assessment, no clear lines at the cement-bone interface and no stem axis changes were detected. Twenty-five of 26 hips showed less than 2 mm of stem subsidence at the final follow-up and one hip showed 2.2 mm stem subsidence. Both hips of one female patient underwent a one stage stem exchange because of an infection that occurred 48 months after revision. No cases showed aseptic loosening up to and including the last follow-up. The Kaplan-Meier survival analysis revealed that the survival rate at five years after revision was 88.0% with any type of re-operation on the femoral side as the endpoint and 100% with aseptic stem loosening as the endpoint, respectively. A biopsy specimen taken from the most proximal part of the reconstructed calcar region at 4 years after surgery in the infected case showed almost complete regeneration of viable bone with normal marrow spaces with partially formed granulation tissue. Conclusion. Reconstruction using metal wire mesh and tightly impacted morcellised allograft is a favorable method for the correction a calcar segmental defect. The procedure is simple and reliable, achieving initial and mid-term stem stability even for femurs with a complete calcar defect