Bulk versus morselized bone graft in acetabular revision total hip replacement.

Use of bulk femoral head autografts and allografts as structural members in complete reconstruction of deficient acetabulae in total hip replacements is associated with a high failure rate after about 5 years. The failures are usually catastrophic requiring reoperations. The reoperation failure rate is eight times greater than those used in primary total hip replacement without structural bone grafting. Contemporary alternatives to bulk structural grafting involves the use of hemispherical, porous, cementless acetabular components fixed with screws and supplementary nonstructural bone grafting. These procedures have proven to be very successful over the short term, and it is hoped that they will provide results superior to those obtained with bulk femoral head allografts. There is also no need to use the bulk femoral head grafts to bring a high hip center down to the normal level.