Acetabular Impaction Grafting in Total Hip Replacement

Abstract

In our series, results were disappointing where a large rim mesh or significant reconstruction was required. In light of these results, our technique has changed in that we now use predominantly larger chips of purely cancellous bone, 8-10 mm3 in size, to fill the cavity and larger diameter cups to better fill the aperture of the reconstructed acetabulum. In addition we now make greater use of i) implants made of a highly porous in-growth surface to constrain allograft chips and ii) bulk allografts combined with cages and morcellised chips in cases with very large segmental and cavitary defects.

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

“…We also observed that all loosened cups did not require rerevision because mild groin pain is well tolerated in some patients [12,25]. Although there is a place for IBG, and the advantage of this method is that if a further operation is required, there is likely to be more living bone present; the poorer result when a large rim mesh was used has led surgeons to consider the use of acetabular tantalum augments combined with or without IBG [27]. Metal augments try to create peripheral acetabular containment to facilitate graft impaction [16].…”

“…Rigby et al [27] and Van Haaren et al [40] also report poor results in patients with these large segmental defects. Rigby et al explain that the mechanism of failure of these cups consisted of movement and rotation of the cup/cement composite within the graft.…”

“…Low rates of aseptic loosening at different followups have been reported using this technique (Table 6). However, other series also report cup migration and bone graft resorption after IBG in revision surgery when used for large segmental defects [27,40]. We therefore evaluated patients undergoing IBG and a cemented cup to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B).…”

“…However, cup migration and bone graft resorption are some of the limitations after IBG in revision surgery when used for large segmental defects despite the use of medial and lateral stainless steel meshes specifically designed to reconstruct segmental bone loss [12,15,27,40]. Because of these concerns, the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.…”

Increased risk for extended acetabular reconstruction in failed hip resurfacing as compared to failed total hip arthroplasty

“…The removal of the acetabular component was conducted with the use of purpose-built components such as the Explant Acetabular Cup Removal System (Zimmer, Warsaw, IN, USA). The occurring bone defects were classified according to the Paprosky classification [21]. Furthermore, defects of the dorsal and ventral column were evaluated as these are not included in the Paprosky classification (Table 3).…”