Reconstruction of metadiaphyseal bone defects of the femur with cortical strut allografts in periprosthetic bone loss

Objective. Biological augmentation and stabilization of high-grade bone defects with structural allografts from donor femur halfs. Indications. Severe bone defects with aseptic loosening of hip prosthesis, periprosthetic femoral fracture or non-union, possibly even in cases of a healed infection. Contraindications. Local or systemic infection. Surgical technique. The two modeled strut allografts are temporary fixed epiperiostal anterolateral and -medial with wire cerclages, while protecting the vascular supplying linea aspera of the femur. With the thus stabilized femur, the leg can be placed in the four-position in order to prepare the medullary canal of the revision prosthesis. Finally, the uncemented revision prosthesis is hammered in under successive tightening of the wire cerclages. With this "cracking technique", stem is stabilized and the grafts have repositioning, augmentative, and supportive function. Postoperative management. Partial weight-bearing postoperatively for 12 weeks. X-ray control during surgery, 10 days postoperatively, after 6 and 12 weeks and every 1-2 years. Results. In four different studies, 123 patients were stabilized from December 1991 to June 2011 due to an extensive periprosthetic femoral bone defect and/or periprosthetic fracture, refracture, or non-union with strut allografts. After an average follow-up of 3.8 years (range 0.3-11 years), the average Harris Hip Score was 80.8 (range 44-100). During this time, there was 1 refracture, 103 stable stems, 20 fibrous stable stems, 9 patients with low graft resorption, and 122 patients with radiographic healing of the strut allografts based on classification according to Emerson et al. (Clin Orthop Relat Res 285:35-44, 1992).