Patch-grafting for regional femoral bone loss in cementless revision hip arthroplasty.

The authors reviewed 33 revision hip arthroplasties using the long-stemmed porous coated anatomic (PCA) prosthesis that required adjuvant patch-grafting for proximal defects of the femur. All hips were revised for aseptic loosening. The mean follow-up period was 3.7 years (2.0-5.8 years). The hips were clinically evaluated by means of the Harris Hip Score: 26 (79%) were found to be good or excellent, 3 (9%) fair and 4 (12%) poor. Graft incorporation occurred in 31/33 cases (94%). Proximal stress protection bone resorption was not seen, although cancellisation of the calcar was noted in 20/33 (60%) hips. Serial radiological review demonstrated some degree of subsidence of the femoral stem in 20/33 (60%) hips. The authors conclude that patch-grafting of the proximal femur at revision surgery incorporates and is not inhibited by the presence of a rigid long-stemmed implant.