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Failure of bulk bone grafts after total hip arthroplasty for hip dysplasia

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Bulk bone grafts are used in total hip arthroplasty (THA) when adequate acetabular cup coverage cannot be achieved. Data from literature show mainly good short-term and mid-term results with contradictory long-term results. The aim of this study was to investigate acetabular cup stability and graft integrity after dysplastic adult hip reconstruction with total hip endoprosthesis and bulk bone graft for acetabular deficiency.

Methods

Seventy-two hips in 64 patients that underwent THA with bone autograft or allograft were assessed immediately after operation, 6 months and 1, 2, 3 and 10 years after operation. Acetabular angle, acetabular cup coverage, bone graft width, and bone graft height were measured and questionnaire was designed to determine acetabular cup stability and grade graft integrity. Four investigators graded grafts and inter-rater and intra-rater reliability of the questionnaire was tested.

Results

All measured parameters in all patients and in patients with autograft and those with allograft separately showed significant changes consistent with graft failure and acetabular cup instability when level of significance was set at p < 0.05.

Conclusions

Results of this study show significant decrease in acetabular cup stability when either autograft or allograft is used for cemented acetabular reconstruction of dysplastic hip. Further, allografts showed twice as rapid failure as autografts. Although these results contradict both good short-term and long-term results in published literature, they present warning for future use of free bulk bone grafts in reconstructive hip surgery.

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References

  1. Hartofilakidis G, Stamos K, Karachalios T, Ioannidis TT, Zacharakis N (1996) Congenital hip disease in adults. Classification of acetabular deficiencies and operative treatment with acetabuloplasty combined with total hip arthroplasty. J Bone Joint Surg 78(5):683–692

    CAS  PubMed  Google Scholar 

  2. Kaneuji A, Sugimori T, Ichiseki T, Yamada K, Fukui K, Matsumoto T (2009) Minimum ten-year results of a porous acetabular component for Crowe I to III hip dysplasia using an elevated hip center. J Arthroplasty 24(2):187–194. doi:10.1016/j.arth.2007.08.004

    Article  PubMed  Google Scholar 

  3. Dorr LD, Tawakkol S, Moorthy M, Long W, Wan Z (1999) Medial protrusio technique for placement of a porous-coated, hemispherical acetabular component without cement in a total hip arthroplasty in patients who have acetabular dysplasia. J Bone Joint Surg 81(1):83–92

    CAS  PubMed  Google Scholar 

  4. Pagnano W, Hanssen AD, Lewallen DG, Shaughnessy WJ (1996) The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg 78(7):1004–1014

    CAS  PubMed  Google Scholar 

  5. Hendrich C, Mehling I, Sauer U, Kirschner S, Martell JM (2006) Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips. J Bone Joint Surg 88(2):387–394. doi:10.2106/JBJS.D.02373

    Article  CAS  PubMed  Google Scholar 

  6. Shinar AA, Harris WH (1997) Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up. J Bone Joint Surg 79(2):159–168

    CAS  PubMed  Google Scholar 

  7. Gerber SD, Harris WH (1986) Femoral head autografting to augment acetabular deficiency in patients requiring total hip replacement. A minimum five-year and an average seven-year follow-up study. J Bone Joint Surg 68(8):1241–1248

    CAS  PubMed  Google Scholar 

  8. Hooten JP Jr, Engh CA, Heekin RD, Vinh TN (1996) Structural bulk allografts in acetabular reconstruction. Analysis of two grafts retrieved at post-mortem. J Bone Joint Surg 78(2):270–275

    Google Scholar 

  9. Delimar D, Cicak N, Klobucar H, Pecina M, Korzinek K (2002) Acetabular roof reconstruction with pedicled iliac graft. Int Orthop 26(6):344–348

    Article  PubMed Central  PubMed  Google Scholar 

  10. Delimar D, Bicanic G, Pecina M, Korzinek K (2004) Acetabular roof reconstruction with pedicled iliac graft: early clinical experience. Int Orthop 28(5):319–320

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Harris WH, Crothers O, Oh I (1977) Total hip replacement and femoral-head bone-grafting for severe acetabular deficiency in adults. J Bone Joint Surg 59(6):752–759

    CAS  PubMed  Google Scholar 

  12. Crowe JF, Mani VJ, Ranawat CS (1979) Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg 61(1):15–23

    CAS  PubMed  Google Scholar 

  13. Mulroy RD Jr, Harris WH (1990) Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg 72(10):1536–1540

    PubMed  Google Scholar 

  14. Marti RK, Schuller HM, van Steijn MJ (1994) Superolateral bone grafting for acetabular deficiency in primary total hip replacement and revision. J Bone Joint Surg 76(5):728–734

    CAS  Google Scholar 

  15. Tsukada S, Wakui M (2012) Bulk femoral head autograft without decortication in uncemented total hip arthroplasty: seven- to ten-year results. J Arthroplasty 27(3):437.e1–444.e1. doi:10.1016/j.arth.2011.06.003

    Article  Google Scholar 

  16. Schofer MD, Pressel T, Schmitt J, Heyse TJ, Boudriot U (2011) Reconstruction of the acetabulum in THA using femoral head autografts in developmental dysplasia of the hip. J Orthop Surg Res 6:32. doi:10.1186/1749-799X-6-32

    Article  PubMed Central  PubMed  Google Scholar 

  17. Kim M, Kadowaki T (2010) High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia. Clin Orthop Relat Res 468(6):1611–1620. doi:10.1007/s11999-010-1288-6

    Article  PubMed Central  PubMed  Google Scholar 

  18. de Jong PT, Haverkamp D, van der Vis HM, Marti RK (2006) Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up. J Bone Joint Surg 88(2):173–178. doi:10.1302/0301-620X.88B2.16769

    Article  Google Scholar 

  19. Inao S, Matsuno T (2000) Cemented total hip arthroplasty with autogenous acetabular bone grafting for hips with developmental dysplasia in adults: the results at a minimum of ten years. J Bone Joint Surg 82(3):375–377

    Article  CAS  Google Scholar 

  20. Rodriguez JA, Huk OL, Pellicci PM, Wilson PD Jr (1995) Autogenous bone grafts from the femoral head for the treatment of acetabular deficiency in primary total hip arthroplasty with cement. Long-term results. J Bone Joint Surg 77(8):1227–1233

    CAS  PubMed  Google Scholar 

  21. Masui T, Iwase T, Kouyama A, Shidou T (2009) Autogenous bulk structural bone grafting for reconstruction of the acetabulum in primary total hip arthroplasty: average 12-year follow-up. Nagoya J Med Sci 71(3–4):145–150

    PubMed  Google Scholar 

  22. Saito S, Ishii T, Mori S, Hosaka K, Nemoto N, Tokuhashi Y (2011) Long-term results of bulk femoral head autograft in cementless THA for developmental hip dysplasia. Orthopedics 34(2):88. doi:10.3928/01477447-20101221-15

    PubMed  Google Scholar 

  23. Busch VJ, Clement ND, Mayer PF, Breusch SJ, Howie CR (2012) High survivorship of cemented sockets with roof graft for severe acetabular dysplasia. Clin Orthop Relat Res 470(11):3032–3040. doi:10.1007/s11999-012-2346-z

    Article  PubMed Central  PubMed  Google Scholar 

  24. Akiyama H, Kawanabe K, Iida H, Haile P, Goto K, Nakamura T (2010) Long-term results of cemented total hip arthroplasty in developmental dysplasia with acetabular bulk bone grafts after improving operative techniques. J Arthroplasty 25(5):716–720. doi:10.1016/j.arth.2009.05.017

    Article  PubMed  Google Scholar 

  25. Lee BP, Cabanela ME, Wallrichs SL, Ilstrup DM (1997) Bone-graft augmentation for acetabular deficiencies in total hip arthroplasty. Results of long-term follow-up evaluation. J Arthroplasty 12(5):503–510

    Article  CAS  PubMed  Google Scholar 

  26. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg 55(8):1629–1632

    CAS  PubMed  Google Scholar 

  27. 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

    Article  PubMed Central  PubMed  Google Scholar 

  28. 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

    Article  PubMed Central  PubMed  Google Scholar 

  29. Delimar D, Bicanic G, Korzinek K (2008) Femoral shortening during hip arthroplasty through a modified lateral approach. Clin Orthop Relat Res 466(8):1954–1958. doi:10.1007/s11999-008-0292-6

    Article  PubMed Central  PubMed  Google Scholar 

  30. Kwong LM, Jasty M, Harris WH (1993) High failure rate of bulk femoral head allografts in total hip acetabular reconstructions at 10 years. J Arthroplasty 8(4):341–346

    Article  CAS  PubMed  Google Scholar 

  31. Bobak P, Wroblewski BM, Siney PD, Fleming PA, Hall R (2000) Charnley low-friction arthroplasty with an autograft of the femoral head for developmental dysplasia of the hip. The 10- to 15-year results. J Bone Joint Surg 82(4):508–511

    Article  CAS  Google Scholar 

  32. Hasegawa Y, Iwata H, Iwase T, Kawamoto K, Iwasada S (1996) Cementless total hip arthroplasty with autologous bone grafting for hip dysplasia. Clin Orthop Relat Res 324:179–186

    Article  PubMed  Google Scholar 

  33. Yamaguchi T, Naito M, Asayama I, Shiramizu K (2004) Cementless total hip arthroplasty using an autograft of the femoral head for marked acetabular dysplasia: case series. J Orthop Surg (Hong Kong) 12(1):14–18

    CAS  Google Scholar 

  34. Spangehl MJ, Berry DJ, Trousdale RT, Cabanela ME (2001) Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: results at five to twelve years. J Bone Joint Surg 83-A(10):1484–1489

    CAS  PubMed  Google Scholar 

  35. Morsi E, Garbuz D, Gross AE (1996) Total hip arthroplasty with shelf grafts using uncemented cups. A long-term follow-up study. J Arthroplasty 11(1):81–85

    Article  CAS  PubMed  Google Scholar 

  36. Shetty AA, Sharma P, Singh S, Tindall A, Kumar SV, Rand C (2004) Bulk femoral-head autografting in uncemented total hip arthroplasty for acetabular dysplasia: results at 8 to 11 years follow-up. J Arthroplasty 19(6):706–713

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

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Conflict of interest

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Zagreb School of Medicine and Clinical Hospital Center Zagreb, Salata 7, 10000, Zagreb, Croatia

    Domagoj Delimar & Goran Bicanic

  2. Department of Orthopaedic Surgery, Clinical Hospital Center Zagreb, Salata 7, 10000, Zagreb, Croatia

    Ana Aljinovic

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  1. Domagoj Delimar
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  2. Ana Aljinovic
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  3. Goran Bicanic
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Correspondence to Ana Aljinovic.

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Delimar, D., Aljinovic, A. & Bicanic, G. Failure of bulk bone grafts after total hip arthroplasty for hip dysplasia. Arch Orthop Trauma Surg 134, 1167–1173 (2014). https://doi.org/10.1007/s00402-014-2006-8

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  • DOI: https://doi.org/10.1007/s00402-014-2006-8

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