Cancellous impaction grafting in femoral revision THA

Options in the management of the deficient femur during revision hip arthroplasty include cemented or cementless fixation. The results with cemented femoral revision have not been historically successful. While the use of extensively coated implants in revision total hip arthroplasty has been more uniformly excellent, issues, such as thigh pain, stress shielding, and lack of bone stock restoration, have been raised. Impaction grafting in revision hip arthroplasty is an attempt to reconstitute bone stock and avoid problems associated with excessively large or long uncemented stems. The original concept of impaction grafting was promoted by Slooff and applied to the femur by Gie and Ling. While originators' results were promising, issues, such as fracture and poor graft delivery, were noted. Modifications to the original technique were recently described by Howie, which used longer stems when necessary, as well as an improved graft delivery system. We report our results with 30 consecutive hips using this method. At follow-up, 3 patients were known to have died, leaving 27 for evaluation. Two of the 27 were failures: 1 recurrence of infection and 1 loose stem. The remaining 25 were clinical successes with bone stock restoration in all and no periprosthetic fractures. We believe that impaction grafting remains a viable option for the management of the severely deficient femur in whom cementless fixation methods are questionable.