Reconstruction of the Shallow Acetabulum With a Combination of Autologous Bulk and Impaction Bone Grafting Fixed by Cement

Abstract

BackgroundAcetabular bone deficiency, especially proximal and lateral deficiency, is a difficult technical problem during primary total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH). We report a new reconstruction method using a medial-reduced cemented socket and additional bulk bone in conjunction with impaction morselized bone grafting (additional bulk bone grafting method).Questions/purposesIn a population of patients with acetabular dysplasia undergoing THA using a medial-reduced cemented socket and additional bulk bone with impacted morselized bone grafting, we evaluated (1) the radiographic appearance of bone graft; (2) the proportion of cups that developed loosening and subsequent revision; and (3) clinical results (outcome scores and complications).MethodsForty percent of 330 THAs for DDH performed at one center between 1999 and 2009 were defined as shallow dysplastic hips. The additional bulk bone grafting method was performed on 102 THAs with shallow acetabulum (31% for DDH) at one center between 1999 and 2009. We used this approach and technique for shallow acetabuli when a cup protruded from the lateral acetabular edge in preoperative templating. The other 132 dysplastic hips without bone grafting had THA performed at the same periods and served as a control. Acetabuli were defined as shallow when the depth was less than or equal to one-fifth of the pelvic height (cranial-caudal length on radiograph). The additional bulk bone grafting technique was as follows: the resected femoral head was sectioned at 1 to 2 cm thickness, and a suitable size of the bulk bone graft was placed on the lateral iliac cortex and fixed by poly-l-lactate absorbable screws. Autologous impaction morselized bone grafting, with or without hydroxyapatite granules, was performed along with the implantation of a medial-reduced cemented socket. We defined an “incorporated” graft as remodeling and trabeculation including rounding off of the protruding edge of a graft beyond the socket. Radiographic criteria used for determining loosening were migration or a continuous radiolucent zone between the prosthesis/bone cement and host bone. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) and the Merle d’Aubigne and Postel score; complications were tallied from chart review. The followup was 10 ± 3 years (range, 6–15 years).ResultsOne acetabular component (1%) with severe shallow and steep acetabuli showed definite radiographic evidence of loosening and was revised. Clinically, the mean JOA score for the hips treated with additional bulk bone grafting THA in this study improved from 39 ± 10 points preoperatively to 95 ± 5 points postoperatively (p < 0.05, paired t-test). The mean Merle d’Aubigne and Postel score for the hips improved from 7 ± 2 points to 17 ± 1 points (p < 0.05, paired t-test). Complications included a Trendelenburg sign in one hip, dislocation in one, and transient partial sciatic nerve palsy in one. Within 3 years 6 months postoperatively, 101 of 102 additional bulk bon...

The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm

“…In the literature, Abdel et al 9 who performed arthroplasty using a femoral head graft reported a mean acetabular component diameter of 48 ± 5.2 mm (range 42–58 mm), and Maruyama et al, 21 in their 102-case study, observed that the acetabular component diameter was 40–50 mm; more than half of the patients had an acetabular component of 48 mm. In the present study, the mean acetabular cup diameter was 49 mm (range 40–60 mm), which is consistent with the literature.…”

“…In the literature, results related to the use of bone autografts vary, which has been attributed to differences in patient selection, degree of dysplasia, patient age and bone quality, grafting technique, graft coverage percentage, and choice of the component. [20][21][22] The use of high hip center technique provides an attractive alternative for reconstruction of the deficient acetabulum. Excellent outcomes, as shown by a minimum 10-year follow up, were accomplished with the high hip center placed by different authors.…”

Inverted reamer technique for bone grafting of the acetabulum: technical note

“…Five methods have been reported for dysplastic hips: proximal positioning of the socket, customized acetabular augments, combination with trabecular metal, bulk bone grafting on the roof of the acetabulum, and impaction bone grafting [ 25 , 26 ]. We advocated that bulk bone grafting is the best in terms of the bone stock and cup position.…”

Preoperative Planning for Total Hip Arthroplasty for Neglected Developmental Dysplasia of the Hip

“…also used cemented cups combined with bulk bone graft to treat dysplasia hips, and after a mean 8 years found no signs of graft collapse or cup loosening. Maruyama et al . used cemented cup combined with bulk bone and impaction bone grafting to treat dysplasia hips.…”