Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements

Abstract

Ann R Coll Surg Engl 2010; 92: 27-30 27The number of patients requiring revision hip arthroplasty is constantly rising. This is a significant orthopaedic challenge due to the extensive bone loss associated with revision surgery which often requires bone grafting. Acetabular reconstruction using bone graft and a cemented polyethylene cup is a reliable and durable technique for revision situations with acetabular bone stock defects. 1It is accepted that all acetabular components will fail in time. 2If extensive areas of bone lysis are not addressed with bone graft during revision, subsequent revisions will be extremely difficult. It is important to attempt reconstruction of the skeleton biologically during revision surgery by using bone graft. Slooff and colleagues 2 published results of impaction grafting demonstrating a stable graft in 79% of cases at 15 years and Ornstein et al.3 produced 71% stable graft at 2-year follow-up. Slooff et al.7 used pure cancellous graft alone whereas Brewster et al.12 used the corticocancellous portion of the femoral head allograft after removing the articular cartilage. There have been no reports in the literature of using the whole femoral head while retaining the articular cartilage. The aim of this paper was to assess the initial mechanical stability and the capacity for biological incorporation and remodelling after impaction grafting using the whole femoral head including residual articular cartilage. Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Some use cancellous graft alone whilst others morselise the whole femoral head after removal of articular cartilage. This paper asks, if it really necessary to use pure cancellous graft? PATIENTS AND METHODS Forty-two acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow-up was 3 years (range, 2-5.6 years). Clinical and radiographic assessment was made using the Oxford hip score, Hodgkinson's criteria (1988) for socket loosening and the Gie classification (1993) for evaluation of allograft consolidation and remodelling. RESULTS Forty (95%) sockets were considered radiologically stable (type 0, 1, 2 demarcations) and two (5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. Twenty-seven(64%) cases showed good trabecular remodelling (grade 3). Twelve (29%) cases showed trabecular incorporation (grade 2). Only three (7%) cases showed poor allograft incorporation (grade 1). Average pre-operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 3 years. CONCLUSIONS Early radiological and clinical survival results with retaining articular cartilage of femo...

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