Experience of structural onlay allografts for the treatment of bone deficiency in revision total hip arthroplasty

Abstract

The use of the cortical onlay allografts provides a feasible option for restoring the integrity of the proximal femur in revision total hip arthroplasty, but the complication rate is high, particularly in female patients with rheumatoid arthritis.

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

“…After a mean follow-up of 13.2 years, only 7 mechanical failures had occurred, and the survival rate of the stem at 16 years was greater than 95%. Recent studies have reported similar low re-revision rates for extensively porous-coated stems in revision THA that range from 0 to 15% after a mean follow-up of 2.1 to 16.1 years [6,[9][10][11][12][27][28][29][30][31][32]. (Table 4) However, the application of extensively porous-coated stems alone in revision THA with type III and IV defects remains a concern because the residual diaphyseal bone may be unable to provide secure stability for the stems [7,8].…”

“…(Table 4) However, the application of extensively porous-coated stems alone in revision THA with type III and IV defects remains a concern because the residual diaphyseal bone may be unable to provide secure stability for the stems [7,8]. Cortical strut allografts can support and provide initial stability for extensively porouscoated stems and can also be used for the treatment of bone deficiency in revision THA [9,11,32]. While the short-term results of extensively porous-coated stems combined with cortical strut allografts in revision THA with femoral bone defects have been encouraging, [9][10][11] few studies have reported longer follow-up results.…”

“…Cortical strut allografts can support and provide initial stability for extensively porouscoated stems and can also be used for the treatment of bone deficiency in revision THA [9,11,32]. While the short-term results of extensively porous-coated stems combined with cortical strut allografts in revision THA with femoral bone defects have been encouraging, [9][10][11] few studies have reported longer follow-up results. Kim et al reported that in 120 patients with severe femoral bone defects, when combined with cortical strut allografts, the survival of extensively porous-coated stems was 91% at 16 years of follow-up [32].…”

“…In such cases, extensively porous-coated stems, when used alone, may lead to a high rate of failure, and other alternative methods are required to provide stable fixation [7,8]. Cortical strut allografts can provide secure initial stability for extensively porous-coated stems and further restore femoral bone stock [9][10][11]. A combination of extensively porouscoated stems and cortical strut allografts is an effective way to reconstruct a femur with severe bone defects.…”

“…A combination of extensively porouscoated stems and cortical strut allografts is an effective way to reconstruct a femur with severe bone defects. Satisfactory short-term outcomes (after a mean followup of 2-5 years), including high survivorship of stems, a high rate of allograft incorporation and the successful restoration of bone stock, have been reported for this technique [9][10][11][12]. However, potential concerns regarding the durability of extensively porous-coated stems with fibrous fixation and resorption of cortical strut allografts over longer follow-up periods have been raised.…”