Introduction: Concerns have been raised regarding both the risk of non-union, and the ability to achieve stability with the use of an ETO in combination with cemented femoral impaction allografting.

Objective: To evaluate the long term follow-up results on all patients using ETO with Impaction Grafting.

Material and Methods: Eighteen patients with a mean age of 61 years were prospectively evaluated. The mean follow-up was 60 months (13 – 114). Charnley-D’aubigne-Postel scores, stem length, ETO length, ETO healing and complications were recorded. No patient was lost to follow-up.

Results: In 13 cases the femur was classified as Paprosky type 3B, in 1 case type 3A and in 4 cases type 4. The mean femoral diameter was 25 mm and the mean osteotomy length was 130 mm. In all cases the stem bypassed the distal osteotomy site with a mean of 58 mm (mean ratio to femoral diameter 2.3). Radiological and clinical healing were achieved in all cases at a mean of 6 months. No evidence of graft-host subsidence or lack of femoral stability was observed.

Conclusion: Further to bone augmentation, Impaction Grafting when performed appropriately protects the osteotomy site from cement interposition leading to a secure bony union of the osteotomy site. The distal osteotomy site should be bypassed by at least 2 ipsilateral femoral diameters. The presence of an ETO did not appear to affect graft stability.