Abstract
Purpose
This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall.
Methods
The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up.
Results
A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4 % of cases, without clinical evidence of hip mobility impairment or pain.
Conclusions
Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.
Similar content being viewed by others
References
Mullaji AB, Shetty GM (2013) Acetabular protrusio: surgical technique of dealing with a problem in depth. Bone Joint J 95-B(11 Suppl A):37–40. doi:10.1302/0301-620X.95B11.32900
Mullaji AB, Marawar SV (2007) Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups: a medium-term radiographic review. J Arthroplasty 22(8):1143–1149. doi:10.1016/j.arth.2006.11.005
Baghdadi YM, Larson AN, Sierra RJ (2015) Long-term results of the uncemented acetabular component in a primary total hip arthroplasty performed for protrusio acetabuli: a fifteen year median follow-up. Int Orthop 39(5):839–845. doi:10.1007/s00264-014-2580-y
Sotelo-Garza A, Charnley J (1978) The results of Charnley arthroplasty of hip performed for protrusio acetabuli. Clin Orthop Relat Res 132:12–18
Pierchon F, Migaud H, Duquennoy A, Fontaine C (1993) Radiologic evaluation of the rotation center of the hip. Rev Chir Orthop Reparatrice Appar Mot 79(4):281–284
Patil N, Hwang K, Goodman SB (2012) Cancellous impaction bone grafting of acetabular defects in complex primary and revision total hip arthroplasty. Orthopedics 35(3):e306–e312. doi:10.3928/01477447-20120222-24
Pereira GC, Kubiak EN, Levine B, Chen FS, Di Cesare PE (2007) Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups. Int Orthop 31(4):445–450. doi:10.1007/s00264-006-0220-x
Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33(2):397–402. doi:10.1007/s00264-008-0683-z
Traina F, De Fine M, Biondi F, Tassinari E, Galvani A, Toni A (2009) The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop 33(6):1513–1518. doi:10.1007/s00264-008-0710-0
Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378. doi:10.5301/HIP.2012.9350
Baghdadi YM, Larson AN, Sierra RJ (2013) Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res 471(10):3251–3259. doi:10.1007/s11999-013-3072-x
Ahmed E, Ibrahim el-G, Ayman B (2015) Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip. Int Orthop 39(1):27–33. doi:10.1007/s00264-014-2554-0
Zahar A, Papik K, Lakatos J, Cross MB (2014) Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop 38(5):947–951. doi:10.1007/s00264-014-2280-7
Murayama T, Ohnishi H, Mori T, Okazaki Y, Sujita K, Sakai A (2014) A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. Int Orthop. doi:10.1007/s00264-014-2613-6
de Campos JP, Schwartsmann CR, Faria M, Bernabé AC, Gomes M, de Luca GJ (2009) Otto pelvis remodeling after total hip arthroplasty. Acta Ortop Bras 1(17):58–61
Grobler GB, Dower BJ, Nortje MB, Walters J (2012) The results of a cementless acetabular component combined with impaction bone grafting in patients with acetabular protrusion. SA Orthop J 11(3):29–33
Baird EO, Kang QK (2009) Prophylaxis of heterotopic ossification - an updated review. J Orthop Surg Res 4:12. doi:10.1186/1749-799X-4-12
Neal BC, Rodgers A, Clark T, Gray H, Reid IR, Dunn L, MacMahon SW (2000) A systematic survey of 13 randomized trials of non-steroidal anti-inflammatory drugs for the prevention of heterotopic bone formation after major hip surgery. Acta Orthop Scand 71(2):122–128. doi:10.1080/000164700317413076
Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z (2011) Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials. Int Orthop 35(1):3–8. doi:10.1007/s00264-009-0886-y
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zuh, SG., Zazgyva, A., Gergely, I. et al. Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion. International Orthopaedics (SICOT) 39, 1757–1763 (2015). https://doi.org/10.1007/s00264-015-2804-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-015-2804-9