Acetabular Reconstruction in Revision Hip Surgery Using Femoral Head Block Allograft

Abstract

This prospective study analyzed the clinical and radiological results of 140 consecutive cases of acetabular revision using large frozen femoral head allografts and cemented all -polyethylene acetabular components. Mean follow-up was 10 years (range: 5-16 years). Thirty patients died, seven were lost to follow-up, and 26 had failed and undergone further surgery. Nineteen failures were due to aseptic failure and collapse of the graft. Kaplan-Meier survival analysis calculated a mean survival at 1 0 years of 88.5% for revision for any reason. We compared all reported techniques of acetabular reconstruction for similar defects and recommend a surgical strategy based on the available evidence, but weighted towards a preference to reconstitute bone stock rather than removing further bone in the revision situation.

Outcome of different reconstruction options using allografts in revision total hip arthroplasty for severe acetabular bone loss: a systematic review and meta-analysis

“…Four studies (14.8%) included Paprosky type 1 to 3 bone defects [ 29 , 40 , 42 , 47 ], whereas 8 studies (29.6%) described only cases with type 2 or 3 [ 31 – 35 , 38 , 43 , 48 ]. Fifteen studies (55.6%) exclusively included Paprosky type 3A and type 3B, respectively [ 24 – 28 , 30 , 36 , 37 , 39 , 41 , 44 – 46 , 49 , 50 ].…”

“…In addition to success rates, the clinical outcomes of the included studies were analyzed. The Harris hip score (HHS) was applied in 16 studies [ 24 , 26 , 27 , 30 – 35 , 37 , 43 – 47 , 49 ] and the modified Merle d’Aubigne (MdA) score in 9 studies [ 28 , 29 , 32 , 36 , 39 – 42 , 50 ]. All publications described improved post-operative outcome scores.…”

“…Aseptic loosening was recorded in 20/27 publications. Twelve of 17 studies reported aseptic loosening in an average of 6.8% of the cases with morselized grafts [ 27 , 30 , 32 , 33 , 37 , 38 , 40 , 41 , 43 , 44 , 47 , 49 ] and in 8/10 studies (80.0%) in 8.3% of the cases with bulk allografts [ 29 , 31 , 35 , 36 , 39 , 45 , 46 , 50 ]. While the aseptic loosening rate was 6.6% in cemented rTHA, cementless procedures reached a loosening rate of 9.2%.…”

Fresh‐frozen allogeneic bone blocks grafts for alveolar ridge augmentation: Biological and clinical aspects

“…Nevertheless, harvesting an AT bone block, has drawbacks; surgery is relatively cumbersome, as it often necessitates the use of a second surgical site, thus adding to patient suffering due to donor site morbidity, extended surgical time, and increased post-surgical pain; there is also a risk for nerve and soft tissue injuries; and occasionally, the quality and quantity of available bone does not allow harvesting of a bone block, for example, in small size jaws after long-term edentulism. 28,29 Allogeneic (AL) bone, in particular fresh-frozen bone (FFB) blocks (i.e., collected from another human, deceased or alive) have been proposed as an alternative to AT bone blocks 30,31 ; AL bone is in general a widely used material, not only in dentistry, but also in orthopedics, with the obvious advantages of unlimited availability and reduced surgical time. 32 Concerns of the past about the use of AL bone, in terms of risk of disease transmission (e.g., hepatitis or HIV) and antigenicity 33,34 have been lessened during recent years due to the very strict guidelines for donor bone tissue sources and processing.…”

“…Therefore, AT bone grafts are often referred to as the gold standard. Nevertheless, harvesting an AT bone block, has drawbacks; surgery is relatively cumbersome, as it often necessitates the use of a second surgical site, thus adding to patient suffering due to donor site morbidity, extended surgical time, and increased post‐surgical pain; there is also a risk for nerve and soft tissue injuries; and occasionally, the quality and quantity of available bone does not allow harvesting of a bone block, for example, in small size jaws after long‐term edentulism 28,29 …”