ASPECTS OF CURRENT MANAGEMENT Impaction allografting in revision total hip replacement

©2006 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.88B7. 17425 $2.00 J Bone Joint Surg [Br] 2006;88-B:852-7. Impaction allografting of bone has been used successfully as a technique to reconstitute bone loss in both the femur and acetabulum in revision total hip replacement (THR) since the pioneering work of the groups in Nijmegen, 1 The Netherlands, and from Exeter, 2 England. The procedure involves progressive compaction of morsellised cancellous bone chips into the femoral canal or acetabular cavity. The prosthesis is then cemented in place, creating a three-layer composite of implant, cement and graft. Longterm outcome studies report a wide variation in results, 1-11 some as high as 100% survival at 10.4 years, 3 others as low as 28% survival at 15.3 years. 4 There are many factors responsible for this variation which can be broadly grouped as follows; the aetiology of failure of the primary THR, the degree of osteolysis, implant choice, surgical technique and bone graft. The purpose of this review is to discuss the current scientific understanding of the influence of the bone graft.