Femoral bone loss after stem removal? How to choose a graft
For hip & knee revision at University Hospitals Cleveland, OH: what to look for in a graft.
You're in the middle of a hip revision at University Hospitals Cleveland. The stem is out, and the femoral canal has an irregular, contained defect. You need a graft that packs into that dead space, holds its shape, and does not leave permanent filler. The defect is contained, so the graft has to stay where you put it.
During a hip revision at University Hospitals Cleveland, stem removal often leaves an irregular femoral defect. This happens because the old stem loosened over time and bone wore away. The bone loss is contained by the remaining cortical wall. That void needs a graft that reaches every edge and stays in place. Chips or blocks can leave gaps or shift during impaction. A moldable synthetic graft packs into the canal without extra instruments.
The graft volume depends on the size of the femoral defect. A small contained void may need only a few cc. A larger cavitary defect may need more. Cost varies by hospital contract and payer. Synthetic graft substitutes usually cost less than BMP-2 and avoid a second surgical site. Taking autograft means a second incision, more pain, and longer healing. The real cost driver is whether the graft remodels into host bone, because permanent filler can complicate a future revision.
This week, ask for a moldable synthetic bone graft substitute for the irregular femoral defect. It should pack into the canal without extra instruments. Avoid rigid blocks that leave dead space or need shaping. You want a graft that remodels into the patient's own bone, not a permanent filler. Ask to see the clinical evidence for remodeling into host bone. Elite Surgical covers cases in University Hospitals Cleveland and can bring ACTIFUSE to your OR for a hands-on look.
Once the defect is packed with a remodeling graft, the femoral canal has no dead space. The graft fills the irregular shape and then gradually turns into host bone. The revision stem sits in a stable bed. The patient heals without a permanent block of filler left behind. At follow-up, the area looks like living bone, not a block of cement. That is the outcome a femoral revision should have.
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Pack the contained defect with a porous synthetic bone graft scaffold. It should hold shape and remodel as the revision heals. Do not leave the defect empty or filled with cement alone.
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Pack the contained defect with a moldable bone graft substitute that has high porosity and remodels into host bone. Avoid autograft if the patient already has a second surgical site. The graft should support the new implant while healing.
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Pick a graft that packs the defect well and has high porosity for bone ingrowth. ACTIFUSE's 80% porous scaffold fills contained defects and remodels into the patient's own bone as the revision heals. For very large defects, consider a moldable version like ACTIFUSE SHAPE to adapt to irregular contours. Avoid grafts that resorb too fast and leave the cup unsupported.
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You need a graft that won't act as a sequestrum. Porous synthetic scaffolds like ACTIFUSE allow vascular ingrowth and antibiotic penetration. They don't provide a hiding place for bacteria the way a structural allograft can. Use it with a staged protocol and appropriate local antibiotics.
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Look for a porous scaffold that holds shape when packed and remodels over time. Match the graft format to the defect. A runny material will not stay in an open femoral defect.
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Elite Surgical handles hip & knee revision in University Hospitals Cleveland and the area around it.