Particulate bone grafting of osteolytic femoral lesions around stable cementless stems

The purpose of the current study: was to evaluate the effect of particulate grafting for proximal femoral osteolysis in the presence of a well-fixed c ementless femoral stem at the time of acetabular liner change or revision. Sixteen patients (17 hips) who averaged 51 years of age underwent curettage and packing of proximal femoral osteolytic lesions with cancellous allogra ft. Modular acetabular liners were changed in 11 patients, acetabular revis ions were performed in six patients, and femoral heads were exchanged in al l patients. The femoral component was retained in all patients. The majorit y of patients were asymptomatic before revision surgery, The size of the fe moral osteolytic lesions was measured preoperatively and postoperatively wi th anteroposterior and Lauenstein lateral radiographs of the hip. Preoperat ively, the average lesion was 41 x 16 mm on the anteroposterior view and 18 x 7 mm on the lateral view. The average clinical and radiographic followup was 39 and 32 months, respectively, with a minimum followup of 24 months. All but one patient remained asymptomatic during the followup period and no femoral stem showed evidence of loosening. The size of the femoral osteoly tic lesion averaged 16 x 6 mm on the anteroposterior view and 6 x 2 mm on t he lateral view at most recent followup. In 15 of 17 patients, the size of the femoral lesion had regressed, This technique seems to be a viable means of preventing progressive osteolysis and femoral loosening while preservin g bone stock for future reconstruction.