[Revision arthroplasty of the hip joint with autologous and homologous cancellous bone].

On revision arthroplasty a substantial loss of bone stock is frequently encountered. To anchor the new prosthesis many different additional technical appliances, e.g. supporting rings, wire meshes and fixation screws, are suggested. However, filling of all the bone cavities by cement will lead to further peripheral defects of bone stock, worsening the situation if renewed loosening occurs. Such loosening must be expected since additional bone is damaged by the implants and the large amount of cement. Therefore, it is increasingly recognized that biologic reconstruction of the deficient acetabulum and femoral shaft by bone grafting should be the goal in revision arthroplasty, in order to restore the bone-implant interface to the site of a primary arthroplasty. Autologous bone graft is harvested from the outer iliac wing as a bone paste most easily by use of an acetabular reamer. As an additional approach is needed and the amount is not always sufficient, often homologous bone is used in solid cortico-cancellous blocks or as a bone paste ground by a bone mill. The bone banking procedure is described. At the acetabulum the grafting technique depends on whether there is a contained or non-contained defect. The cup has to be brought to the anatomical position and should be supported at several sites by the original iliac bone and not only by the graft. At the shaft, osteotomy of the greater trochanter can be avoided by a lateral transgluteal approach in the vast majority of cases (90 out of 95 cases). If still possible, a short stem is preferred to an extra-long one. Follow-up examination of 164 patients at 46 months (min. 24, max. 78 months) after cup revision showed that 8 re-revisions had been performed in the meantime: in 6 cases renewed loosening or infection had been treated by implantation of a new component; in 2 cases a Girdlestone procedure was the final outcome.