Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects.

When the proximal femur is absent due to a failed femoral stem in total hip arthroplasty, impacted bone grafts contained within circumferential meshes could be an alternative reconstructive method. The purpose of this study was to analyse the initial resistance to axial and rotational forces in a fresh frozen bovine model with complete loss of the proximal femur reconstructed with a circumferential metal mesh, impacted bone allografts and a long cemented stem. Four bovine femurs with a complete proximal bone defect were reconstructed with a circumferential mesh, impacted bone grafts and a cemented stem. The results were compared with four intact femurs using the same implant. Under axial load, subsidence was observed at an average of 617 kg in the experimental group, and a cortical fracture occured at 1335 kg in the control group. Under rotational load, experimental femurs failed at an average of 79 kg and the control femurs fractured at 260 kg. This model provided 50% of the resistance to axial load and 30% of the resistance to rotational load compared to an intact femur, which is enough to resist physiological load. This stability encourages the use of circumferential meshes, impacted bone allografts and cemented stems in revision hip surgery with massive bone loss.