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

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Summary

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.

Résumé

Nous avons effectué 21 arthroplasties totales avec greffe d'une partie de la tête fémorale chez 19 patients porteurs d'une dysplasie ou d'une luxation congénitale de hanche. Une couverture de la cupule cotyloïdienne par greffe autologue vissée a été réalisée. Un cotyle de Charnley, small ou extra-small a été implanté dans 20 cas et une pièce fémorale miniature dans 15 cas. Les résultats de ces 20 hanches ont été appréciés avec un recul moyen de 10 ans (de 5 à 14 ans). Dix-neuf hanches étaient indolores. La greffe avait fusionné sans résorption dans 18 cas, 2 greffes présentaient une importante résorption associée à un descellement cotyloïdien. Des résultats satisfaisants à lointaine échéance peuvent être obtenus dans les dysplasies sévères par l'utilisation de pièces prothétiques adaptées et reconstruction du cotyle par greffe. La médialisation du centre de la hanche et le recours à de petits cotyles sont de la plus grande importance pour assurer un support adéquat de la prothèse par l'os greffé, de façon à diminuer les contraintes auxquelles il est soumis. La tête fémorale fournit une quantité d'os suffisante pour reconstruire le cotyle.

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Authors and Affiliations

  1. Clinica Ortopedica dell' Universita' di Frenze, Italy

    G. Stringa, G. V. Di Muria & M. Marcucci

  2. Orthopaedische Uniklinik der Friedrich-Alexander Universität, Rathsbergerstrasse 57, D-91054, Erlangen, Germany

    R. P. Pitto

Authors
  1. G. Stringa
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  2. R. P. Pitto
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  3. G. V. Di Muria
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  4. M. Marcucci
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Stringa, G., Pitto, R.P., Di Muria, G.V. et al. Total hip replacement with bone grafting using the removed femoral head in severe acetabular dysplasia. International Orthopaedics 19, 72–76 (1995). https://doi.org/10.1007/BF00179963

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