Clinical and radiological results of impaction bone allograft technique in acetabular revisions associated with massive bone stock deficiencies: Four to seven years follow-up study

El-Kawy, S.; D, Hay; Drabu, K J

doi:10.1177/112070000501500107

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…The impaction bone grafting (IBG) technique was introduced for use in the acetabulum by Slooff et al [35] and has proven to be effective in revision surgery. Different series have confirmed excellent results using this technique [10,30,32,33] and bone graft incorporation has been reported in histologic and positron emission tomography studies [2,4,28,31,34,37]. In a goat model of impacted allograft, Schimmel et al [28] showed complete incorporation of the allograft by 48 weeks.…”

Section: Introductionmentioning

confidence: 78%

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

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and 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.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects 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). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

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Section: Introductionmentioning

confidence: 78%

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

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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“…Impacted morselized bone allograft and cement in the acetabulum have been used in revision surgery [13,18,37,48] and bone graft incorporation has been reported in histologic studies [5,41,44,47]. However, most series reporting impaction bone grafting in acetabular revision surgery do not establish differences between different defects of differing severities.…”

Section: Discussionmentioning

confidence: 99%

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

García-Cimbrelo

Cruz-Pardos

García-Rey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Impaction bone grafting has been used for acetabular reconstruction in revision surgery. However, most series do not establish differences in survival in revisions with differing severity of bone loss. Questions/purposes We therefore determined (1) the survival rate for rerevision associated with varying degrees of bone loss; (2) the frequency with which bone graft resorption occurred; and (3) whether the reconstruction restored the anatomic center of rotation of the hip. Methods We retrospectively reviewed 165 patients (181 hips) who underwent rerevision for major bone loss. Using the classification of Paprosky et al. 98 hips had a Grade 3A defect and 83 a Grade 3B. We determined survival rates for revision and graft resorption. Cup position was determined measuring vertical and horizontal positions and the distance from the center of the prosthetic femoral head to the normal center of rotation of the hip in both groups according to Ranawat. The minimum followup until rerevision or the latest evaluation was 0.3 years months (mean, 7.5 years; range, 0.3-17.7 years). Results The survival rate for revision at 8 years was 84% (95% confidence interval: 61-100) for Grade 3A and 82% (95% confidence interval: 68-100) for Grade 3B. Twelve hips were rerevised. Seventeen grafts showed bone resorption. Acetabular cup position was anatomically restored in both Grades 3A and 3B. Conclusions The midterm results for impacted bone allograft and cemented all-polyethylene cups were similar in both Grade 3A and Grade 3B hips. Acetabular reconstruction allows anatomic positioning of the cups and is associated with a low rate of rerevision.

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“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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%.…”

Section: Discussionmentioning

confidence: 99%

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

Strahl

Boese

Ries

et al. 2023

Arch Orthop Trauma Surg

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Introduction Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available. Material and methods Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system. Results Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22–95). The average follow-up period was 7.9 years (range 2–22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87–93]. Trabecular metal augments (93% [76–98]) and shells (97% [84–99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons). Conclusion Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts. Clinical trial registration PROSPERO: CRD42020223093.

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Clinical and radiological results of impaction bone allograft technique in acetabular revisions associated with massive bone stock deficiencies: Four to seven years follow-up study

Cited by 7 publications

References 16 publications

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

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

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

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

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