Thirty-seven patients with extensive acetabular defects due to loose implants had revisions with uncemented components, the acetabulum being augmented with homograft bone. In six of these, a histological study of graft incorporation was made. At a mean follow-up of 1.5 years 34 patients were free of pain and 35 could walk for 30 minutes or longer. No graft had obviously sequestrated. Two components had radiological evidence of migration but remain asymptomatic. We conclude that cementless revision surgery with homograft supplementation of the acetabulum is clinically successful in the short-term. The long-term outcome is unknown.

Fifty-three failed knee replacements were revised using minimally constrained implants with smooth uncemented intramedullary stems and metal-backed tibial components. Polymethylmethacrylate was used only to replace lost bone near the surface of the implant. Excluding four knees which had serious postoperative complications, 91% had successful relief of pain, 84% had over 90 degrees of movement and 80% could walk for more than 30 minutes. Review of the radiographs showed that there were no progressive lucencies at the interface between bone and cement, and no subsidence of components or changes in alignment. At the uncemented stem-to-bone interface, thin white lines developed near the metal, and their significance is discussed. This revision technique is an effective treatment for aseptic failure of primary total knee arthroplasty.