A modified version of the impaction bone grafting technique was introduced in 1985. The use of a moldered metallic mesh to protect the graft from excessive cement penetration was promoted as well as to reinforce the reconstruction mechanically. The length of the revision stem was chosen to achieve distal fixation and to bridge the bone loss to prevent subsidence and postoperative femoral shaft fracture. The 8-year stem survivorship was 100% and 92.8 ± 6.8% at 12.5 years of follow-up. This technique achieved cortical and cancellous reconstruction in every case without postoperative femoral shaft fracture or significant subsidence. The clinical and radiological results are long lasting. However, the duration of surgery and the risk of viral agent's transmission by using extensive bone grafting may restrict the use of this technique.
To address femoral bone loss in revision total hip arthroplasty (THA) we developed a technique involving impaction allografting with intramedullary mesh moulded around the revision stem, to prevent excessive cement penetration of the allograft. The length of the revision stem was determined by the extent of femoral bone loss. Between 1986 and 1998, 32 such procedures were undertaken on 28 patients. The mean pre-operative HHS for function was 22 (range 5 to 42), improving to 41 (range 12 to 47) at final follow-up. Only 1 patient presented with aseptic loosening after revision at 147 months (12.2 years). The 12.5 year survivorship for the stem was 92.8%. The technique has provided stable and durable reconstruction, with good new bone formation visible radiologically. It is technically demanding and time consuming, but it avoids the previously published problem of massive subsidence within the bone graft.
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