Supportive strut grafts for diaphyseal bone defects in revision hip arthroplasty

Large femoral cortical strut allografts were used to provide structural support of the femur in 20 patients in whom uncemented, extensively porous-coated, press-fit revision femoral stems were applied. The mean followup was 4.7 years. Radiographic analysis of the patients who had revision surgery revealed that in all 20 patients, the cortical femoral strut allografts showed incorporation. Small areas of graft resorption were observed in only two patients. Seventeen of the uncemented femoral revision stems radiographically showed bone ingrowth. Three of the revision femoral stems were interpreted as being fixed only by fibrous ingrowth after early subsidence after surgery. There were no reoperations. Before surgery, all patients were unable to walk and had severe pain. At followup, all patients were ambulatory and had considerable improvement in pain relief and in their ability to walk. The mean Harris hip score after surgery was 75 (range, 57.5-92). Complications consisted of one peroneal nerve palsy, which resolved; one deep venous thrombosis; one gastrointestinal ulcer; and one case of pneumonia. Supportive cortical strut allografts represent an alternative to the use of circumferential bulk allografts and total femoral replacements in patients with large combined proximal and diaphyseal bone defects.