Impaction bone grafting for the reconstitution
of bone stock in revision hip surgery has been used for nearly 30 years.
Between 1995 and 2001 we used this technique in acetabular reconstruction,
in combination with a cemented component, in 304 hips in 292 patients
revised for aseptic loosening. The only additional supports used
were stainless steel meshes placed against the medial wall or laterally
around the acetabular rim to contain the graft. All Paprosky grades
of defect were included. Clinical and radiographic outcomes were
collected in surviving patients at a minimum of ten years after
the index operation. Mean follow-up was 12.4 years ( Cite this article:
Aseptic loosening of the acetabular component continues to be the most common indication for revision of total hip replacements in younger patients. Early in the evolution of the cemented hip, arthroplasty surgeons switched from removal to retention of the acetabular subchondral bone plate, theorising that unfavourable mechanical forces were the cause of loosening at the bone-cement interface. It is now known that the cause of aseptic loosening is probably biological rather than mechanical and removing the subchondral bone plate may enhance biological fixation of cement to bone. With this in mind, perhaps it is time to revive removal of the subchondral bone as a standard part of acetabular preparation.