Total hip reconstruction using frozen femoral head allografts in patients with acetabular bone loss.

Major acetabular bone loss associated with failed total hip replacements can be managed successfully using frozen femoral heads as structural allografts during revision surgery. In 29 cases followed for an average period of 3.9 years, all of the grafts showed radiographic evidence of union. Five hips showed clinical or radiographic evidence for acetabular loosening. Three of these hips required reoperations for symptomatic loosening. In two of these, sufficient bone stock was present to permit another revision without further bone grafting. Twenty-five of the remaining 26 hips were functioning satisfactorily with a mean Harris score of 84 points. In view of the major bone loss following multiple previous operative procedures in these young patients, the results of revisions using structural femoral head allografts were clearly superior to those with resection arthroplasty, the most likely alternate solution. Graft resorption, lack of posterior coverage, and incomplete cement mantle contributed to the failures.