Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement

Abstract

Impaction bone grafting for the reconstitution of bone stock in revision hip surgery has been used for nearly 30 years. Between 1995 and 2001 we used this technique in acetabular reconstruction, in combination with a cemented component, in 304 hips in 292 patients revised for aseptic loosening. The only additional supports used were stainless steel meshes placed against the medial wall or laterally around the acetabular rim to contain the graft. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of ten years after the index operation. Mean follow-up was 12.4 years (sd 1.5) (10.0 to 16.0). Kaplan-Meier survival with revision for aseptic loosening as the endpoint was 85.9% (95% CI 81.0 to 90.8) at 13.5 years. Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose.

Prevalence of and Risk Factors for Hip Resurfacing Revision

“…The 10-year implant survival rate following revision of THRs due to late aseptic loosening was reported to be 84% in a large cohort, with patients with surviving implants having good functional outcomes 42 . Similar outcomes have been demonstrated in other studies following revision THR 43,44 . Given that many MoMHR implants may still require revision because of pseudotumor and the substantial difference between the outcomes following revisions of MoMHRs and those following revision of THRs, regular surveillance of patients with MoMHRs is important coupled with a low threshold for considering revision surgery.…”

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

“…Metal augments try to create peripheral acetabular containment to facilitate graft impaction [16]. Different series have been recently published reporting good preliminary results [3,13,15,16].…”

“…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.…”

Azetabuläre Revision: Rekonstruktion kavitärer und segmentaler Defekte unter besonderer Berücksichtigung modularer hoch poröser Pfannensysteme

“…This article provides an overview of relevant literature and implant-specific features of different reconstruction strategies. [3,4]. Zur Versorgung azetabulärer Defektsituationen sind eine Vielzahl von Therapiestrategien beschrieben [5,6].…”

“…Klassifikation azetabulärer Defekte nach Paprosky et al[7].wird von nahezu allen Autoren kryokonservierter allogener Knochen verwendet, der in Form von Spänen oder Chips mit speziellen Instrumenten und/oder geschlossenen Probepfannen in den zu versorgenden Defekt impaktiert wird[4,24]. Vor allem die Arbeitsgruppe um Slooff et al berichtete in einer Kohorte von 62 konsekutiv versorgten Patienten über ausgezeichnete mittel-Mittel-bis langfristige Ergebnisse der Pfannenrevision mit großen Press-fit-Pfannen.…”