[Reconstitution of femoral bone stock in loosening of total hip prosthesis].

Between 1986 and 1990, 18 femoral loosenings were treated for severe destruction with an original technique. The average age of the 16 patients was 62 years. Two hips had a second loosening. According to the score of Merle d'Aubigné the pain was evaluated at a mean of 2.1 preoperatively. The gait was scored 1 in half of the patients. The prostheses were trochanterodiaphyseal in 14 patients and self-locking in 4 patients. The aim of this technique was: 1. to bridge the diaphyseal bone loss by healthy cortical bone, for good primary stability, 2. to reconstruct the bone stock with fragmented allografts, 3. to avoid mixing grafts and cement, by using an interposed titanium net. The frequent postoperative complications (2 fractures, 4 diaphyseal bursts, 6 false channels) occurred during extraction of the cement. Weightbearing was allowed after an average of 2 months postoperatively. With a follow-up of 33.4 months, the functional result was excellent in 11 cases (score 17 and 18). No massive resorption of the endomedullary graft was observed; trabeculation of the graft was seen in 8 patients. No migration of the prosthesis was noted. In later years, there will be a problem of extracting the rod, and there exists a risk of stress shielding, due to the length of the stem.