Supportive strut grafts for diaphyseal bone defects in revision hip arthroplasty

Large femoral cortical strut allografts were used to provide structural sup port of the femur in 20 patients in whom uncemented, extensively porous-coa ted, press-fit revision femoral stems were applied, The mean followup was 4 .7 years. Radiographic analysis of the patients who had revision surgery re vealed that in all 20 patients, the cortical femoral strut allografts showe d incorporation, Small areas of graft resorption were observed in only two patients, Seventeen of the uncemented femoral revision stems radiographical ly showed bone ingrowth, Three of the revision femoral stems were interpret ed as being fixed only by fibrous ingrowth after early subsidence after sur gery, There were no reoperations, Before surgery, all patients were unable to walk and had severe pain, At followup, all patients were ambulatory and had considerable improvement in pain relief and in their ability to walk. T he mean Harris hip score after surgery was 75 (range, 57.5-92), Complicatio ns consisted of one peroneal nerve palsy, which resolved; one deep venous t hrombosis; one gastrointestinal ulcer; and one case of pneumonia, Supportiv e cortical strut allografts represent an alternative to the use of circumfe rential bulk allografts and total femoral replacements in patients with lar ge combined proximal and diaphyseal bone defects.