Structural allografts for bone stock reconstruction in two-stage revision for infected total hip arthroplasty: Good outcome in 16 of 18 patients followed for 5–14 years

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Abstract
The use of massive bone allografts in cases of revision of failed total hip arthroplasties (THAs) due to infection is controversial. 18 patients presented with infection at the site of a THA and were treated with a two-stage protocol. In the first stage, the prosthesis was removed together with all necrotic tissues and cement material if present. A custom-made mold of Palacos R cement containing 1 g of gentamicin was then inserted in 17 of the 18 patients. Systemic antibiotics were used during the interval period. In the second stage, the patients had either acetabular or femoral reconstruction using bulk allograft bone. Mean follow-up was 9 (5-14) years. 1 patient presented with recurrent infection and underwent a Girdlestone resection arthroplasty as definitive treatment. Another patient had a mechanical failure of the acetabular component, which was revised 10 years after the second stage of the reconstruction. The mean Harris Hip Score improved from 34 points preoperatively to 71 points at the last review. By our definition, 16/18 of the patients had a successful outcome. Our results support the use of massive allografts in staged reconstructions of infected THAs complicated by considerable bone loss.