Histological Findings in a Proximal Femoral Structural Allograft Ten Years Following Revision Total Hip Arthroplasty

Failure of the femoral component with progressive bone loss is an important long-term complication of total hip arthroplasty. Among the different methods that have been advocated for dealing with massive femoral structural defects, bone-grafting is the only currently available procedure for restoring bone stock1-7. At the institution of the senior one of us (M.K.), a method to deal with deficient proximal femoral cortical bone was developed in 1987 and has been in use since that time8. This technique consists of impaction of a proximal femoral structural allograft into the host femur. A femoral component of standard length then is cemented only into the allograft. The clinical and radiographic results have been satisfactory, with one revision among twenty-seven procedures after a mean of five years of follow-up8. However, the underlying process of incorporation of a massive allograft remains unknown. To the best of our knowledge, there are no reports in the literature of the long-term results of histological evaluation of a massive allograft following revision total hip arthroplasty. The aim of this report is to address the issue of long-term incorporation and remodeling of a femoral structural allograft.