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J Am Acad Orthop Surg, Vol 14, No 11, October 2006, 620-628.
© 2006 the American Academy of Orthopaedic Surgeons
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Impaction Bone Grafting for Revision Hip Arthroplasty: Biology and Clinical Applications

Daniel A. Oakes, MD and Miguel E. Cabanela, MD

Dr. Oakes is Assistant Professor of Clinical Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA. Dr. Cabanela is Professor of Orthopaedic Surgery, Mayo Clinic College of Medicine, Rochester, MN.

Neither Dr. Oakes nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. Cabanela or the department with which he is affiliated has received research or institutional support from Stryker. Dr. Cabanela has received royalties from Stryker. Dr. Cabanela serves as a consultant to Stryker.

Reprint requests: Dr. Cabanela, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Impaction bone grafting techniques are useful when the orthopaedic surgeon is faced with large cavitary acetabular defects or a large ectatic femoral metaphysis or diaphysis. Impaction bone grafting of the acetabulum involves packing of cavitary defects with compressed particulate graft, followed by insertion of either a cemented or cementless acetabular component. Impaction grafting of the femur involves retrograde filling of the femoral canal with impacted particulate graft, creating a neomedullary canal into which a cemented femoral stem can be placed. Use of the impaction allografting technique is appealing, especially in young patients, because of its potential to restore bone stock. The technically demanding nature of the procedure, the risk of complications, and the unknown long-term fate of the impacted allograft highlight the need for ongoing assessment of this technique for revision total hip arthroplasties.




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