抄録
Loss of femoral bone stock in a patient who needs revision surgery presents a difficult challenge to the orthopaedic surgeon. In this study, we focused on difficult cases of bone defects distal to the lesser trochanter, and femoral shaft fractures, with implant loosening. Seven hips were categorized in this class. In these cases, implants should be fixed with the distal part of the femur, however the geometry of the femoral canal is extended distally. To solve this problem, we used a modified impaction grafting technique to make a tapered neo-canal in the extended femoral canal. Combined with impacting morsellized allografts or hydroxyapatite granules, a long stem was fixed with PMMA bone cement. After an average follow-up period of 2.6 years, an average JOA clinical hip score was improved to 75.5 points from 47.9 points preoperatively. One stem was loosened, as seen radiographically. One hip had further revision surgery due to recurrent dislocation. The other five hips showed no loosening nor complications. These results indicated that our method could be one solution to fix a long stem in the distal femoral canal.
