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Femoral Revision With Impaction Bone Grafting and Cement
Femoral impaction grafting is a technique used to restore femoral bone stock in revision hip surgery. It involves the impaction of morcellized allograft bone into the femoral canal. The original technique, first used in the United Kingdom in 1987, requires introduction and pressurization of acrylic bone cement (polymethyl methacrylate) into a neomedullary canal formed by the compacted graft and the use of a polished tapered collarless femoral implant. The use of specially designed instruments allows tight compaction of the allograft chips with consistent alignment of the prosthesis in the medullary canal. Retrieval specimens and biopsies of impacted material have shown that the bone is often incorporated and remodeled, making good bone stock available for further revision procedures if required. Stainless steel wire meshes have been designed to constrain allograft chips in patients with uncontained defects in the proximal femur. Stability of the graft is achieved by vigorous impaction of allograft chips into the contained defect, allowing subsequent bony remodeling. Further reinforcement of the femur with strut allograft may be required. Long stems may be indicated in femurs that are deficient beyond the metaphyseal area. Specialized instruments allow impaction of the graft as far as 260 mm down the femur.