Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique

Abstract

Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail. Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication. Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.

Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes

“…Custom triflanged cups and custom-made implants are reserved for extreme defects. Differently, biological reconstructions with bone grafting offer the added advantage of improving and potentially restoring bone stock for future revisions, which is particularly important in young patients [ 11 ]. Some authors do not recommend the latter procedure as the first choice because it may be technically demanding and time-consuming as compared with non-biological techniques, with the risk of graft resorption and infection.…”

Partial Two-Stage Exchange for Infected Total Hip Arthroplasty: A Treatment to Take into Account

“…For the acetabular reconstruction, three cases with minor defects underwent TMT with revision shell (cases 3, 5 and 8). Case 1 had a combination of trabecular metal supplements and morselised bone graft, as reported previously by the senior author [ 15 ]. In three cases (cases 2, 4 and 6), all of them with pelvic discontinuity, the reconstruction was performed with fixation of the superior to the inferior hemipelvis by using pelvic reconstruction plating in combination with trabecular metal supplements and cup–cage construction.…”

Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis

“…The incidences of symptomatic deep venous thrombosis, infection, dislocation, and surgical revision were also estimated ( 37 ). No significant difference was found between the UWB and PWB groups regarding the abovementioned complication ( Table 4 and Figure 4 ).…”