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Outcomes of Impaction Bone Grafting in the Management of Acetabular Defects with the Use of Uncemented Acetabular Cups: Do Autografts and Irradiated Femoral Head Allografts Integrate?

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Abstract

Introduction

Acetabular impaction bone grafting (AIBG) has been used widely to reconstruct acetabular defects in complex primary and revision cases. The aim of this study was to look at the outcomes AIBG using either frozen irradiated femoral head allografts or autografts with uncemented acetabular cups.

Method

We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays.

Result

There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan–Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10–24) and post-operative OHS was 39 (range 21–48) (p < 0.001).

Conclusions

The mid- to long-term results for AIBG and uncemented acetabular cups is good. With newer and more porous uncemented cups especially revision cups, it may serve as an extended indication to achieve solid fixation together with AIBG technique in managing acetabular defects of ≤ 3A.

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Acknowledgements

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No funding was needed in this study.

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Authors and Affiliations

  1. Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia

    Hak Lian Teh, Veenesh Selvaratnam, Wei Jian Low, Ahmad Fauzey Kassim & Suresh Chopra

  2. Joint Reconstruction Unit, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Veenesh Selvaratnam & Wei Jian Low

  3. Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Putrajaya, Malaysia

    Shubash Shander Ganapathy

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Contributions

THL—writing and editing paper. All authors read and approved the final manuscript. VS—writing and editing paper. LJW—data collection and analysis. AFK—data collection and editing paper. SSG—statistical analysis. SC—editing paper and data analysis.

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Correspondence to Veenesh Selvaratnam.

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Teh, H.L., Selvaratnam, V., Low, W.J. et al. Outcomes of Impaction Bone Grafting in the Management of Acetabular Defects with the Use of Uncemented Acetabular Cups: Do Autografts and Irradiated Femoral Head Allografts Integrate?. JOIO 57, 1842–1849 (2023). https://doi.org/10.1007/s43465-023-00983-7

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