REVISION TOTAL HIP-ARTHROPLASTY - THE USE OF SOLID ALLOGRAFT

Intact solid allograft was used to augment severe bone loss in 8 aceta bula and 15 femora in 22 patients who under-went revision total hip ar throplasty with noncemented implants. The average follow-up period was 4 years. The average time to radiographic union of whole acetabular a llografts was 11 months. Superior migration of the allografts occurred in four patients. Varus tilt of the acetabular component within the a llografts was noted in three patients. Eleven patients underwent entir e proximal femoral allograft reconstruction, and four patients had fem oral head allograft reconstruction. Nine patients with entire proximal femoral allografts achieved radiographic union at an average of 13 mo nths and two failed by nonunion. Only one of the four patients with fe moral head allograft reconstruction achieved union. Femoral component subsidence was noted in seven whole proximal femoral allografts (64%). Entire proximal femoral allograft reconstruction was complicated by a t least one episode of postoperative dislocation in 6 of 11 procedures . The authors recommend that femoral head allografts should be used wi th caution to reconstruct proximal femoral deficiencies in which struc tural support is required for stability of the implant. Successful use of acetabular allografts requires that the majority of the allograft be contiguous to host bone and not to soft tissue. With entire proxima l femoral reconstruction, the tip of the femoral component should not reside at the host-graft junction. All components should be cemented i nto allograft bone; and revision surgery should be performed before os teolytic destruction of bone advances to the point where allograft rec onstruction is required.