Abstract
Introduction: The reconstruction of the severely deficient proximal femur is more commonly achieved with a large composite proximal femoral allograft and a prosthesis.
Aim: To review our experience with this technique in 19 revision total hip arthroplasties (18 patients) treated between December 1988 and January 1997.
Cases: There were 15 females and three males. The average age was 56 years (32 to 78 years). The primary diagnoses included osteoarthritis (seven), rheumatoid arthritis (six), congenital dislocation (two), avascular necrosis (one), septic arthritis (one), and ankylosing spondylitis (one). Each underwent an average of three (range: one to 9) previous hip operations. The average time from the previous operation was 10.65 years (0.25 to 25). All hips had significant periprosthetic osteopenia and bone loss on preoperative radiographs. Five had previous infections with two subsequent Girdlestone arthroplasties. Six presented with periprosthetic fractures and loose components.
The hips were approached posteriorly. A step cut was used to secure the host to allograft junction. The femoral component was cemented within the allograft and with a press-fit in the host bone. All but three cases had iliac crest bone graft and/or residual host bone chips added to the host-allograft site. The acetabulum was revised concurrently in 13 (two whole acetabular allografts).
Results: The average period of follow-up was 57.6 months(range: 25 to 127 months). The time taken to heal was estimated radiographically as less than 8.5 months (range: three to 18 months). The average Harris Hip Scores improved from 25.6 to 75.53. One patient complained of persistent pain post-operatively. The complications included proximal migration of the greater trochanter in five, one infection that was converted to a Girdlestone excisional arthroplasty 27 months later, and seven patients with dislocations.
Conclusions: Allograft prosthetic reconstruction of the proximal femur is a durable construct with up to ten years follow-up. This technique preserved host bone while providing additional bone for future reconstruction. There was substantial improvement in function with low complication rates.
The abstracts were prepared by Professor A. J. Thurston. Correspondence should be addressed to him at the Department of Surgery, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
