Femoral Revision with Impaction Grafting and a Collarless, Polished, Tapered Stem

Femoral impaction allografting has been done with and without variations of the original description. The purpose of this study was to review Harris hip scores, radiographs, and complications in patients in whom we used the original technique without significant modifications. Preoperative and postoperative hip scores and radiographic data were available at a mean of 4.7 years for 43 of 44 hips that had femoral component impaction allografting with a collarless, polished, tapered stem. Bone stock was classified according to the Endo-Klinik classification. Survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97%. The mean Harris hip score improved from 45 to 90 with pain improved in all. Subsidence 4 mm and greater occurred in only two hips, but neither has been revised. One hip was revised for mechanical loosening after a fall on the surgically treated extremity 6 years after surgery. Complications included three intraoperative fractures, one femoral fracture recognized postoperatively, one trochanteric nonunion, and one dislocation. Femoral component revision with impaction allografting and a collarless, polished, tapered stem was reproducible and improved Harris hip scores in patients with aseptic femoral component loosening and bone loss at a mean of 4.7 years after surgery.

Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.