Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device with bone allograft

Abstract

We retrospectively reviewed 40 hips in 36 patients who had undergone acetabular reconstruction using a titanium Kerboull-type acetabular reinforcement device with bone allografts between May 2001 and April 2006. Impacted bone allografts were used for the management of American Academy of Orthopaedic Surgeons Type II defects in 17 hips, and bulk bone allografts together with impacted allografts were used for the management of Type III defects in 23 hips. A total of five hips showed radiological failure at a mean follow-up of 6.7 years (4.5 to 9.3), two of which were infected. The mean pre-operative Merle d'Aubigné score was 10 (5 to 15) vs 13.6 (9 to 18) at the latest follow-up. The Kaplan-Meier survival rate at ten years, calculated using radiological failure or revision of the acetabular component for any reason as the endpoint, was 87% (95% confidence interval 76.3 to 97.7). A separate experimental analysis of the mechanical properties of the device and the load-displacement properties of bone grafts showed that a structurally hard allograft resected from femoral heads of patients with osteoarthritis should be preferentially used in any type of defect. If impacted bone allografts were used, a bone graft thickness of < 25 mm was acceptable in Type II defects. This clinical study indicates that revision total hip replacement using the Kerboull-type acetabular reinforcement device with bone allografts yielded satisfactory mid-term results.

Acetabular Reconstruction Using a Trabecular Metal Cup with a Novel Pelvic Osteotomy Technique for Severe Acetabular Bone Defect

“…There are two main concepts in acetabular reconstruction: one is to achieve rigid containment and recover bone stock using metal mesh or reinforcement devices with bone grafting to stabilize the cemented cup and the other is to achieve bone ingrowth using a cementless cup with or without bone grafting or augmentation devices. Surgical techniques representative of the former concept include a cemented cup with a reinforcement plate [ 5 , 6 ], a cage [ 7 ], or impaction bone grafting [ 8 , 9 ]. The success of these techniques depends on achieving adequate initial stability followed by a biological response of graft incorporation and remodeling.…”

Long-Term Outcome of Acetabular Reconstruction Using a Kerboull-Type Acetabular Reinforcement Device with Hydroxyapetite Granule and Structural Autograft for AAOS type II and III Acetabular Defects

“…Kawanabe et al reported that the 10-year survival rates using the Kerboull plate in morselized and bulk graft group were 53% and 82%, respectively [16]. Akiyama et al reported that the survival rate using the KT plate with bulk and morselized allografts at 10 years was 87% [14]. Hori et al reported a survival rate of 92.3% for the KT plate with bulk and morselized allografts at 10 years [22].…”

“…because the KT plate is more elastic than Kerboull plate, the yield points of the inferior hook and of the pallet of the KT plate were reached at displacements of approximately 1 mm and 4 mm, respectively [14]. The Kerboull plate was used in 9 hips and the KT plate was used in 31 hips.…”

Bone graft incorporation after revision hip arthroplasty in patients with rheumatoid arthritis, seventy eight revisions using bone allografts with or without metal reinforcements

“…Slightly better results were published by Akiyama et al, with the same type of reinforcement ring and bone grafts. Survival rate, calculated using radiological failure or revision, was 87 % at ten years [15], but their patients had less severe acetabular bone defects than patients of Hori et al [14]. Bohm and Banzhaf reported a rate of 89 % with three reconstruction alternatives in 103 cases that were followed up for 0.3–13 years [16].…”