Uncemented Acetabular Components with Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip

Abstract

We previously reported the five to twelve-year results of total hip arthroplasty with an uncemented acetabular component and an autogenous femoral head graft in forty-four consecutive hips with developmental dysplasia. The goal of the present study was to report the implant survival rate, status of bone grafts, and clinical outcomes in thirty-five of these hips (in twenty-nine patients) followed for a mean of 21.3 years. Functional, radiographic, and survivorship results were examined. Radiographic analysis revealed an average cup inclination angle of 43° and a mean arc of cup coverage by the graft of 30°. The twenty-year survivorship free from acetabular revision was 66% (twelve acetabular revisions; eight since our previous report). Of the twelve revisions, nine were for liner wear and/or osteolysis, one was for a liner fracture, one was for aseptic loosening, and one was for instability. All bone grafts healed to the pelvis. The graft facilitated revision cup placement as no additional structural grafts or metal augments were required. We concluded that an uncemented porous-coated socket used in conjunction with a bulk femoral head autograft provides good long-term fixation and restores bone stock.

Tritanium acetabular wedge augments: short-term results

“…Whether the cause of such defects is DDH or osteolysis present in a failed THA, reconstruction needs to be addressed accordingly (2-4). Technology has evolved from the use of structural allografts (5,6) to the use of cages (7,8), jumbo cups (9-11), and acetabular augments (12,13), depending on the size and location of the defect. Superiority of one over the others has not been reached (20).…”

“…There are numerous publications on how to manage various acetabular defects (2)(3)(4). Due to lack of resources, the initial treatment for these types of defects was structural allografts (5,6). Later on, newer technology allowed the use of cages (7,8), jumbo cups (9-11), and most recently, acetabular augments have been added to our armamentarium (12,13).…”

Total Hip Replacement in Developmental Dysplasia of the Hip: Pitfalls and Challenges

“…Noncemented acetabular components with grafts have same survival rates like the cemented acetabular components, with revision rates of 0-5% [43,44]. The 20-year survivorship free from acetabular revision was 66% for noncemented acetabular components with femoral head as autograft [45]. In another study, 57% of the acetabular components underwent revision at a mean of 14.6 years because of osteolysis [46].…”

Anatomic placement of the acetabulum improves the survival rate in patients with Crowe type-II dysplasia undergoing total hip arthroplasty

“…Therefore, recent literatures suggest placing the acetabular component in the anatomic hip-center for different types of DDH. Several techniques have been used to reconstruct the acetabulum during THA in DDH patients, including augmentation with bone grafting with cemented or noncemented acetabular component (7)(8)(9) or using high hip centre (10,11) when there is no better choice. Yet, there still remain some controversies as to whether a high hip center, particularly without bone graft, is the best option for patients with severe hip dysplasia.…”

“…Contrastingly, superior non-anatomical placement without lateral displacement is acceptable. Horizontal displacement of the acetabular component was found to be an adverse factor and isolated superior displacement was considered unrelated to loosening of the acetabular component (7)(8)(9)15).…”