Abstract
Background
Reconstructions in case of acetabular bone loss in hip revision arthroplasty are challenging. A few techniques have been proposed, with inconstant outcomes. Biological reconstructions using bone allografts may address the acetabular bone loss and restore the hip anatomy. Aim of this work was the description of the surgical technique and the evaluation of the outcomes using a regional arthroplasty register.
Materials and methods
Minor or massive bone allografting was performed in hip revision arthroplasties in a tertiary center. Bulk allografts were used in severe acetabular bone losses. Fresh-frozen femoral heads were impacted in the bone cavity and porous cups were implanted; multihole sockets were used when necessary. In DeLee A zone, no grafts were used in order to reduce overstress graft resorption. The results were evaluated using a regional arthroplasty register, and a comparison with revisions without bone grafts was performed investigating re-revision rates and reasons for further revisions.
Results
At 10 years, acetabular revisions with bone allografts achieved a similar survival rate than revisions without bone grafts. The re-revisions occurred more frequently in revisions without bone allografts (10.8 vs. 9.7%). In the allograft cohort, septic loosening was lower (0.3 vs. 2.6%), whereas a higher rate of aseptic cup loosening was experienced (2.7 vs. 1.4%).
Conclusions
Bone allografts may provide a good restoration of the acetabular bone stock and the hip biomechanics. Septic loosening does not seems a major concern, whereas a higher rate of aseptic cup loosening should be expected when bone grafts are used.
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References
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133
Lamo-Espinosa J, Duart Clemente J, Díaz-Rada P, Pons-Villanueva J, Valentí-Nín JR (2013) The Burch–Schneider antiprotrusio cage: medium follow-up results. Musculoskelet Surg 97(1):31–37
Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG (2013) Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21(3):128–139
Chen AF, Hozack WJ (2014) Component selection in revision total hip arthroplasty. Orthop Clin North Am 45(3):275–286
Kim YH (2017) Acetabular cup revision. Hip Pelvis 29(3):155–158
Hourscht C, Abdelnasser MK, Ahmad SS, Kraler L, Keel MJ, Siebenrock KA, Klenke FM (2017) Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: high failure in pelvic discontinuity. Arch Orthop Trauma Surg 137(8):1139–1148
Pulido L, Rachala SR, Cabanela ME (2011) Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants. Int Orthop 35(2):289–298
Stihsen C, Hipfl C, Kubista B, Funovics PT, Dominkus M, Giurea A, Windhager R (2016) Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component. Bone Joint J 98(6):772–779
Trumm BN, Callaghan JJ, Liu SS, Goetz DD, Johnston RC (2012) Revision with cementless acetabular components: a concise follow-up, at a minimum of twenty years, of previous reports. J Bone Joint Surg Am 94(21):2001–2004
Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast 9(1):33–44
Bilgen OF, Bilgen MS, Oncan T, Danış M (2012) Acetabular reconstruction by impacted cancellous allografts in cementless total hip arthroplasty revision. Acta Orthop Traumatol Turc 46(2):120–125
Brubaker SM, Brown TE, Manaswi A, Mihalko WM, Cui Q, Saleh KJ (2007) Treatment options and allograft use in revision total hip arthroplasty the acetabulum. J Arthroplast 22(7 Suppl 3):52–56
Sporer SM, O’Rourke M, Chong P, Paprosky WG (2006) The use of structural distal femoral allografts for acetabular reconstruction. J Bone Joint Surg Am 88(Suppl 1 Pt 1):92–99
Piriou P, Norton M, Marmorat JL, Judet T (2005) Acetabular reconstruction in revision hip surgery using femoral head block allograft. Orthopedics 28(12):1437–1444
Paprosky WG, Sporer SS, Murphy BP (2007) Addressing severe bone deficiency: what a cage will not do. J Arthroplast 22(4 Suppl 1):111–115
Traina F, Giardina F, De Clerico M, Toni A (2005) Structural allograft and primary press-fit cup for severe acetabular deficiency. A minimum 6-year follow-up study. Int Orthop 29(3):135–139
Dearborn JT, Harris WH (1999) High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg Am 81(4):469–480
Castagnini F, Sudanese A, Bordini B, Tassinari E, Stea S, Toni A (2017) Total knee replacement in young patients: survival and causes of revision in a registry population. J Arthroplast 32(11):3368–3372
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The last senior Author has received benefits for personal and professional use from a commercial party related directly and indirectly to the subject of this article (Zimmer, Warsaw, US; CeramTec, Plochingen, Germany; Adler Ortho, Milan, Italy, Cremascoli Ortho). The other authors declare that there is no potential conflict of interest relevant to this article.
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Busanelli, L., Castagnini, F., Bordini, B. et al. The biological acetabular reconstruction with bone allografts in hip revision arthroplasty. Musculoskelet Surg 103, 173–179 (2019). https://doi.org/10.1007/s12306-018-0573-5
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DOI: https://doi.org/10.1007/s12306-018-0573-5