The use of structural bone allografts in revision total hip arthroplasty: biology and clinical applications

Techniques using structural allografts are useful when the orthopaedic surgeon is faced with large segmental and sometimes cavitary acetabular defects, or segmental defects affecting the proximal femoral metaphysis. On the acetabular side this technique usually involves bolting the graft to the ileum, followed by insertion of a cementless acetabular component if the allograft supports less than 40% of its circumference or the use of a cage when it is estimated that the allograft will support more than 40% of a cup circumference. On the femoral side, the technique involves the use of a composite consisting of a proximal femoral allograft and cemented femoral prosthesis. Use of these techniques is appealing, especially in young patients, because of its potential to restore bone stock. The present chapter will discuss the biology, indications, techniques and the results with the use of structural allografts in cases of revision hip arthroplasty