Impaction Grafting for Revision Total Hip Arthroplasty

Impaction grafting for revision total hip arthroplasty is increasingly being used in cases complicated by substantial bone loss. Many techniques using cemented and noncemented designs with or without bone graft have had unpredictable outcomes and are the source of continuing debate. This new technique uses morselized allograft, impacted into a constrained femoral envelope, creating a new medullary canal into which a collarless, polished, tapered stem is cemented. Preliminary results of impaction grafting have been positive. However, the aspects crucial to its success remain unclear. Complications following this procedure are similar to those seen with other types of revision procedures. Many surgeons familiar with the limitations of the impaction grafting systems are modifying the original technique. Further investigation is necessary to establish which aspects of impaction grafting are critical to its success. This article reviews the principles behind the development of this procedure, its complications, limitations, and some modifications currently being used.