Long-term results of acetabular reconstruction using irradiated allograft bone

Abstract

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

Mid‐ to Long‐term Follow‐up of Severe Acetabular Bone Defect after Revision Total Hip Arthroplasty Using Impaction Bone Grafting and Metal Mesh

“…Green et al . reported longer term survivorship of 80.6% at 15 years 13 . Furthermore, Gerhardt et al .…”

“…IBG for the acetabulum has been advocated as an effective method, with excellent long‐term survival, for reconstructing acetabular bone defects 13 . Autologous bone remains the best source of bone for reconstructing bone defects because it is osteoconductive and osteogenic 26 .…”

“…The impacted bone allows good initial stability of the cemented acetabular component and restoration of bone stock 12 . Although irradiated bone is mechanically weak, its advantage is the reduced possibility of disease transmission, and the clinical follow‐up results of IBG using irradiated fresh‐frozen allograft in acetabular reconstruction are acceptable 13 . In particular, the combination of IBG and metal mesh with a cemented acetabular component has been successfully employed in redesigning acetabular anatomy 14 .…”

Acetabular Revision Arthroplasty Based on 3-Dimensional Reconstruction Technology Using Jumbo Cups

“…Presently, numerous surgical tools and strategies have been developed to resolve the dilemma caused by the acetabular defect. In this view, some of the approaches are a combination of compact grafting with cups ( Green et al, 2018 ), jumbo cups ( von Roth et al, 2015 ; McLaughlin and Lee, 2018 ), rings or cages ( Innocenti et al, 2021 ), shells with a high HCOR ( Russell et al, 2021 ), and cup–cage constructs ( Wang et al, 2020 ). The use of jumbo cups is a common and effective technique to treat extensive acetabular defects.…”

Primary stability of a press‐fit cup in combination with impaction grafting in an acetabular defect model

“…has shown satisfying clinical results in acetabular and femoral hip revision surgery. 6,7 However, supply of donor bone is limited and very expensive. Furthermore, the preparation of bone chips in the operating room is time consuming and the quality of the produced bone chips differs widely due to biological variation and preparation technique.…”