Intramedullary step-cut osteotomy for revision total hip arthroplasty with allograft-host bone size mismatch

Eleven revision total hip arthroplasties were treated with proximal segmental femoral allograft reconstruction in which the diameter of the distal host bone was larger than the largest long-stem femoral component which could fit into the segmental allograft. A long, lateral step-cut osteotomy of the allograft was used with placement of the lateral cortical allograft inside the distal host bone. All allograft-host bone junctions healed. The average time to union was 6.7 months. The long step-cut osteotomy provides stability of the allograft-host bone junction when the diameter of the host bone is larger than the allograft. The osteotomy also provides a large surface area of contact between the allograft and host bone.