Impacted Autograft and Cementless Components in Acetabular Revision: A Retrospective Series

Abstract

Objective

A retrospective review of the short- to medium-term results of acetabular revision using impacted autograft combined with cementless acetabular components is reported. Methods; Twenty-five cases with aseptic acetabular loosening and associated bone defects were revised using impacted autograft and a cementless acetabular component.

Results

Twenty-five patients were followed for a minimum of 4 years. Mean follow-up was 5.5years (range 4.0–8.0 years). Radiographs showed that good incorporation of autograft occurred in all cases. Mean Harris hip score improved from 36.0 points (range 20.0 to 50.0) pre-operatively to 85.7 points (range 50.0 to 91.0) at latest follow-up. Outcome was Excellent in 8 cases, Good in 13 cases and Fair in 4 cases. No cases required further revision.

Conclusion

The use of impacted autograft in combination with cementless components for acetabular revision can achieve good short- to medium-term result in patients with acetabular bone deficiency.

Keywords

Acetabulum Autograft Total hip replacement Revision

Get full access to this article

View all access options for this article.

References

Georg

, Sabine

. Revision of failed acetabular components utilizing a cementless oblong cup: an average 9-year follow-up study. J Arch Orthop Trauma Surg. 2009; 129: 603–8.

Etienne

, Bezwada

H.P.

, Hungerford

D.S.

, Mont

M.A.

. The incorporation of morselized bone grafts in cementless acetabular revisions. Clin Orthop Relat Res 2004; 428: 241–6.

Daniel

K.P.

, Craig

J.D.

, Laura

. Revision of the Acetabular Component without Cement. J Bone Joint Surg Am. 2009; 91: 350–5.

Harris

W.H.

. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969; 51: 737–75.

Lachiewicz

P.F.

, Poon

E.D.

. Revision of a total hip arthroplasty with a Harris-Galante porous-coated acetabular component inserted without cement: a follow-up note on the results at five to twelve years. J Bone Joint Surg Am 1998; 80: 980–4.

Conn

R.A.

, Peterson

L.F.A.

, Stauffer

R.N.

, Ilstrup

. Management of acetabular deficiency: long-term results of bone grafting the acetabulum in total hip arthroplasty. Orthop Trans 1985; 9: 451–2.

Robinson

A.H.

, Palmer

C.R.

, Villar

R.N.

. Is revision as good as primary hip replacement? A comparison of quality of life. J Bone Joint Surg Br 1999; 81: 42–5.

Boldt

J.G.

, Dilawari

, Agarwal

, Drabu

K.J.

. Revision total hip arthroplasty using impaction bone grafting with cemented nonpolished stems and Charnley cups. J Arthroplasty 2001; 16: 943–52.

Arts

J.J.

, Verdonschot

, Buma

, Schreurs

B.W.

. Larger bone graft size and washing of bone grafts prior to impaction enhances the initial stability of cemented cups: experiments using a synthetic acetabular model. Acta Orthop 2006; 77: 227–33.

10.

Della

V.C.

, Shuaipaj

T.B.

, Rosenberg

A.G.

. Revision of the acetabular component without cement after total hip arthroplasty. A concise follow-up, at fifteen to nineteen years, of a previous report. J Bone Joint Surg Am 2005; 87: 1795–800.

11.

Palm

, Jacobsson

S.A.

, Kvist

. Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7–11) years follow-up. J Arthroplasty 2007; 22: 1083–91.

12.

Valle

A.G.

, Zoppi

, Peterson

M.G.

, Salvati

E.A.

. Clinical and radiographic results associated with a modern, cementless modular cup design in total hip arthroplasty. J Bone Joint Surg Am 2004; 86: 1998–2004.

13.

Della Valle

C.J.

, Berger

R.A.

, Rosenberg

A.G.

, Galante

J.O.

. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res. 2004; 420: 96–100.

14.

Dunlop

D.G.

, Brewster

N.T.

, Madabhushi

S.P.

, Usmani

A.S.

, Pankaj

, Howie

C.R.

. Techniques to improve the shear strength of impacted bone graft: the effect of particle size and washing of the graft. J Bone Joint Surg Am 2003; 85: 639–46.

15.

Oakley

, Kuiper

J.H.

. Factors affecting the cohesion of impaction bone graft. J Bone Joint Surg Br 2006; 88: 828–31.

16.

Ullmark

. Bigger size and defatting of bone chips will increase cup stability. Arch Orthop Trauma Surg 2000; 120: 445–7.

17.

Goldberg

V.M.

, Stevenson

. Natural history of autografts and allografts. Clin Orthop Relat Res 1987; 225: 7–16.

18.

Parratte

, Argenson

J.N.

, Flecher

, Aubaniac

J.M.

. Acetabular revision for aseptic loosening in total hip arthroplasty using cementless cup and impacted morselized allograft. Rev Chir Orthop Reparatrice Appar Mot 2007; 93: 255–63.

19.

Fan

C.Y.

, Chen

W.M.

, Lee

O.K.

, Huang

C.K.

, Chiang

C.C.

, Chen

T.H.

. Acetabular revision arthroplasty using jumbo cups: an experience in Asia. Arch Orthop Trauma Surg 2008; 128: 809–13.