What is the long-term survival of impaction allografting of the femur?

Background: Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures. Questions/purposes: We therefore asked what the survivorship of impaction bone grafting was at longer followup, if the severity of bone loss was associated with failure, and finally, if longer length stems had improved survival compared with shorter stems. Methods: Between 1993 and 2002, 78 femoral revisions were performed in 71 patients using impaction grafting. The average age of the patients was 67 years (range, 33-84 years). Sixty-nine of the 71 patients were available for followup evaluation. We obtained Harris hip scores preoperatively and postoperatively. Radiographs were measured for radiolucent lines. Patients were followed a minimum of 2 years (average, 10.6 years; range, 2-19 years). Results: Survival of the femoral component without revision for any cause was 93% (confidence interval [CI], 83%-97%) and for aseptic loosening was 98% (CI, 87%-100%) at 19 years. Neither severity of bone loss nor the length of the stem predicted failure. Conclusions: Impaction bone grafting has a high survival of 93% at the 19-year followup for patients with severe bone loss of their femur. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.