Combined Strut Onlay Allografting, Reduction Osteotomy, and Extensively Porous-Coated Stem for Reconstruction of Severe Femoral Defects During Revision Hip Arthroplasty

Background: The purpose of this study is to determine the long-term (up to 27 years) results of a modified technique applying strut allografts combined with a reduction osteotomy over an extensively porous-coated stem. Methods: We reviewed the results of 399 revision total hip arthroplasties (for aseptic loosening in 390 hips and septic loosening in 9 hips) in 369 patients (mean age 58 +/- 13 years, range 22-65) performed with an extensively porous-coated femoral stem combined with a cortical strut onlay allograft. The mean follow-up was 23 years (range 20-27). Results: The mean Harris Hip Score was 84 +/- 16 points (range 35-100) at the final follow-up. The mean Western Ontario and McMaster Universities Osteoarthritis Index score was 21 +/- 16 points (range 12-53) at the final follow-up. The mean University of California Los Angeles activity score was 6.1 points (range 5-8). A Kaplan-Meier survivorship analysis at 23 years of follow-up showed that the survival rate of the femoral component was 95.5% (95% confidence interval 89-98) with aseptic loosening or revision for any reason and it was 91.5% (95% confidence interval 85-95) if septic loosening was included. Conclusion: We found good results in terms of longevity and functional outcome using this modified technique. Future mechanical studies in addition to controlled clinical studies are warranted. (c) 2021 Elsevier Inc. All rights reserved.