Total hip replacement with bone grafting using the removed femoral head in severe acetabular dysplasia

Abstract

We carried out total hip replacement and femoral head bone-grafting in 21 hips with congenital dysplasia or dislocation, obtaining as much support of the cup by the host bone as was possible. A Charnley small or extra small cup was implanted in 20 cases and a miniature femoral component in 15. The results of 20 hips were reviewed prospectively at an average of 10 years. Nineteen patients had no pain. Three cups showed radiological signs of loosening, one was causing other symptoms. All the stems, except one, were radiologically stable and were symptomless. The graft had fused without resorption in 18 cases. Two grafts showed severe resorption with loosening of the cup. Satisfactory long term results of total hip replacement and femoral head bone-grafting can be achieved using special surgical techniques and the appropriate components. Medialisation of the hip and the use of small cups are important in allowing sufficient support of the prosthesis by bone so that the distribution of load on the graft is minimised. The grafted femoral head provides suitable bone stock for reconstruction of the acetabulum.

Impaction grafting and acetabular reinforcement in revision hip replacement

“…The radiological appearance of the mixed grafts during the healing phase observed in our study corresponded with that seen with pure autografts [24].…”

Structural bone grafting in arthroplasty for congenital hip dysplasia: 35 hips followed for 5-10 years

“…The mean age of our patients was 54 years, similar to those mentioned in other studies (Wolfgang 1990, Stringa et al 1995, Shinar and Harris 1997. Their function improved from 37 points preoperatively to 85 postoperatively on the Hams Hip Score.…”

Acetabular reconstruction in developmental hip dysplasia using reinforcement ring with a hook

“…The RR facilitates reproducible reconstruction of the anatomic hip centre by positioning the hook around the inferior margin of the acetabular floor (incisura acetabuli), a consistent landmark despite severe deformity and bonestock deficiency. Several clinical studies show that implant placement in the true acetabulum is essential to restore the function of the abductor mechanism and to achieve adequate host-bone coverage [14,22,24]. In contrast, poor long-term results have been reported when THR was performed with high hip-joint centre [7,15,25].…”

“…Total hip replacement (THR) for secondary osteoarthritis in developmental hip dysplasia remains a difficult and challenging procedure. Modern cementing techniques and new design of femoral components have substantially improved the long-term prognosis of stem stability [5,22,25]. On the other hand, in severe acetabular deformities with marked bone-stock deficiencies, implant fixation becomes a technical hazard and continues to be considered an unsolved issue [3,7,15].…”