HIP ARTHROPLASTY WITH MORSELISED CANCELLOUS BONE INTO THE FEMORAL CANAL

Abstract

Introduction and Objectives: We analysed a series of 27 patients who underwent salvage total hip replacement and femoral packing with bone bank allograft for the treatment of femoral defects. We analyzed results clinically and radiographically.

Materials and Methods: This study involved 27 hip salvage surgeries in 27 patients. The patients were treated between March 1997 and April 1999 with a follow-up period of 4–6 years. Femoral defects were classified according to AAOS criteria. Clinical results were assessed using the Harris scale. Radiographic studies were performed postoperatively, at 6 months, at one year after treatment, at 4 years, and in 6 cases, at 6 years. We also analysed clinical complications, technical problems, and sinking of the prosthesis into the femoral canal.

Results: Of these patients, 80% did not present with pain one year after treatment, and 85% could walk without assistance. The graft was incorporated in 90% of cases. Sinking of the prosthesis without indications of loosening occurred in less than 50% of cases. In one patient is was necessary to repeat treatment due to sinking and loosening of the femoral component, and in another case it was necessary to remove the prosthesis due to infection.

Discussion and Conclusions: The method of impaction of morselised cancellous bone into the femoral canal as described by Ling et al. has been shown in recent years to be reliable and reproducible in cases of femoral canal defects resulting from osteolysis and significant losses of cortical bone. Bone stock is restored, thus paving the way for future revisions with distal diaphyseal attachment revision prosthesis. Continued evaluation of the allograft impaction technique in femoral component revision shows optimal results after 5 years of follow up.