Morsellized allografts for fixation of the hip prosthesis femoral component: A mechanical and histological study in the goat

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Abstract
To simulate femoral intramedullary bone stock loss in revision surgery of failed total hip arthroplasties, a method was developed using impacted trabecular bone grafts. In 14 goats a cemented total hip arthroplasty was performed, fixating the stem within a circumferential construction of bone allografts. After 6 or 12 weeks, 4 goats were used for mechanical tests and 3 for histology. The stability of the stems was determined in a loading experiment with roentgen-stereophotorammetric analysis; loads of up to 1.44 times body weight were used. One aseptic loosening was seen with gross movements. In the other cases the most important movements were axial rotations (max 0.24 degrees under 800 N) and axial translations (max. 0.16 mm under 800 N). After unloading some elastic recovery occurred. There were no differences between the 6 and 12-week groups. Histoogically, revascularization and remodeling of the grafts were evident. Bone apposition and bone resorption of the grafts resulted in a mixture of graft and new bone. There was more new bone formation in the 12-week group, but the process was not yet completed. The use of impacted trabecular bone grafts in cases of severe intramedullary bone stock loss seems to be a promising revision technique.