Cancellous Impaction Bone Grafting of Acetabular Defects in Complex Primary and Revision Total Hip Arthroplasty

Abstract

The reconstruction of major acetabular bone defects during revision, conversion, and primary total hip arthroplasties (THAs) is challenging. We reviewed a consecutive series of 168 THAs (108 revisions, 8 conversions, and 52 primary THAs) performed by 1 surgeon (S.B.G.) between 1997 and 2008 using impaction bone grafting for acetabular reconstruction. Autograft, cancellous allograft croutons, and demineralized bone matrix were used to fill bone defects as needed. The acetabular bone deficiency was classified according to the American Academy of Orthopaedic Surgeons: type I, segmental deficiency with significant rim defect; type II, cavitary defects medially or posteriorly; type III, combined cavitary and segmental deficiency; type IV, pelvic discontinuity; and type V, arthrodesis. According to this method, 56 hips had type I, 31 hips had type II, 48 hips had type III, and 27 hips had type IV deficiencies. Of the 168 patients, 19 subsequently died of causes unrelated to the THA, and 11 were lost to follow-up. All patients had at least 2 years of follow-up. Average Harris Hip Score improved from 45.5±17.9 preoperatively to 81.1±16.5 postoperatively (P<.05) for revision THAs, from 40.0±11.3 preoperatively to 85.0±12.8 postoperatively (P<.05) for conversion THAs, and from 42.3±14.9 preoperatively to 85.0±12.0 postoperatively (P<.05) for primary THAs. All impaction grafted bone (allograft, autograft, or a combination) incorporated radiographically, thus restoring bone stock. Complications included 1 early infection, which was managed successfully with debridement and liner exchange, and 2 late infections that were managed successfully with staged revision. Two revisions required subsequent re-revision for late loosening. Two hip dislocations occurred, 1 of which required surgical treatment to place a constrained liner.

Percutaneous Vertebroplasty Using Fresh Frozen Allogeneic Bone Chips as Filler

“…However, if it is fully charged in a closed space, it can have a solid nature to bear a compression force, much like wet sand 24). This concept has already been accepted in total hip arthroplasty for reconstruction of bone defect 25). Fresh allogeneic bone has osteoconductivity and weak osteoinductivity compared to freeze-dried allogeneic bone or synthetic bone substitute.…”

The management of acetabular malunion with traumatic arthritis by total hip arthroplasty

“…Bone grafting may be an advisable method to deal with it. 14 , 15 For the patients of small cavity-pattern acetabular defect (<25mm), granular autogenous bone grafting (5~10mm cancellous particles) from femoral head could be used. While for the cases of large cavity-pattern defect (>25mm), it is advised to use the autogenous femoral head or allogeneic bone to perform the structural bone grafting.…”

The healing response to implants used in joint replacement

“…This process may take up to a year to complete in man, and even after this time it may still be possible to detect the original bone graft fragments by examination by polarised light microscopy, when collagen fibre lamellar patterns and reversal lines together with the presence of empty osteocyte lacunae are the tell-tale signs of the graft. The long-term success of impaction bone grafting in hip revision surgery has recently been reported (te Stroet et al, 2012;Iwase et al, 2012;Ten Have et al, 2012;Patil et al, 2012;Masterson et al, 2012). When used in large blocks, cortical bone becomes incorporated only at the edges where there is an interface with the original bone.…”