Abstract
Impaction grafting is controversial in the presence of segmental and cavitary acetabular defects and requires the use of supplemental devices to close segmental defects. This approach, however, would allow treating combined deficiencies that could not be managed with impacted cancellous bone alone. We raised the following two questions: (1) What is the survival rate in patients with combined deficiencies reconstructed with metal mesh, impaction grafting and a cemented cup and (2) can metal mesh prevent cup migration? We evaluated 23 cavitary uncontained acetabular defects in revision hip arthroplasty. Preoperative diagnoses were aseptic loosening (19 hips) and second-stage reimplantations after resection for infection (four hips). The preoperative Merle D’Aubigné-Postel score averaged 7.4 points. Two patients had reoperations for mechanical failure at 6 and 24 months. The survival rate with further revision as an end point was 90.8% at an average of 36 months (range, 24–56 months; 95% confidence interval, 68.1–97.6). Metal mesh did not prevent cup migration: migration occurred in all patients, averaging 5.1 mm (range, 2–25 mm). Another three patients with severe combined defects had asymptomatic mesh rupture with 3- to 15-mm migration. Postoperative functional score averaged 16.2 points. Metal mesh, impaction grafting, and a cemented cup should be considered for reconstruction of medium uncontained acetabular defects, but not for severe combined deficiencies.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup: measurement of angle after total hip replacement. J Bone Joint Surg Br. 1986;68:409–413.
Azuma T, Yasuda H, Okagaki K, Sakai K. Compressed allograft chips for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Br. 1994;76:740–744.
Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;74:711–715.
Berry DJ, Sutherland CJ, Trousdale RT, Colwell CW Jr, Chandler HP, Ayres D, Yashar AA. Bilobed oblong porous coated acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res. 2000;371:154–160.
Bolder SB, Schreurs BW, Verdonschot N, Veth RP, Buma P. Wire mesh allows more revascularization than a strut in impaction bone grafting: an animal study in goats. Clin Orthop Relat Res. 2004;423:280–286.
Boldt JG, Dilawari P, Agarwal S, Drabu KJ. Revision total hip arthroplasty using impaction bone grafting with cemented nonpolished stems and Charnley cups. J Arthroplasty. 2001;16:943–952.
Buttaro M, Araujo GS, Araujo ES, Comba F, Piccaluga F. Viability of impacted bone allografts under calcar metal mesh in revision surgery of the hip: case report. J Bone Joint Surg Br. 2008;90:228–231.
Comba F, Buttaro M, Pusso R, Piccaluga F. Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2- to 13-year follow-up study of 142 aseptic revisions. J Bone Joint Surg Br. 2006;88:865–869.
Comba F, Buttaro M, Pusso R, Piccaluga F. Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years. Int Orthop. 2008 Feb 9 [Epub ahead of print].
D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–137.
D’Aubigné RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.
Dearborn JT, Harris WH. 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. 1999;81:469–480.
Dearborn JT, Harris WH. Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. J Arthroplasty. 2000;15:8–15.
DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
Fawcett K, Barr AR. Tissue Banking. McLean, VA: American Association of Tissue Banks; 1987.
Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ. Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br. 1993;75:14–21.
Gill TJ, Sledge JB, Muller ME. The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg Br. 1998;80:946–953.
Goodman S, Saastamoinen H, Shasha N, Gross A. Complications of ilioischial reconstruction rings in revision total hip arthroplasty. J Arthroplasty. 2004;19:436–446.
Gustilo RB, Pasternak HS. Revision total hip arthroplasty with titanium ingrowth prosthesis and bone grafting for failed cemented femoral component loosening. Clin Orthop Relat Res. 1988;235:111–119.
Harris WH. Allografting in total hip arthroplasty: in adults with severe acetabular deficiency including a surgical technique for bolting the graft to the ilium. Clin Orthop Relat Res. 1982;162:150–164.
Harris WH, Jones WN. The use of wire mesh in total hip replacement surgery. Clin Orthop Relat Res. 1975;106:117–121.
Jasty M. Jumbo cups and morsalized graft. Orthop Clin North Am. 1998;29:249–254.
Jasty M, Harris WH. Results of total hip reconstruction using acetabular mesh in patients with central acetabular deficiency. Clin Orthop Relat Res. 1988;237:142–149.
Jasty M, Harris WH. Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts. J Bone Joint Surg Br. 1990;72:63–67.
Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.
Katz RP, Callaghan JJ, Sullivan PM, Johnston RC. Long-term results of revision total hip arthroplasty with improved cementing technique. J Bone Joint Surg Br. 1997;79:322–326.
Kelley SS. High hip center in revision arthroplasty. J Arthroplasty. 1994;9:503–510.
Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res. 2000;378:155–168.
Koster G, Willert HG, Kohler HP, Dopkens K. An oblong revision cup for large acetabular defects: design rationale and two- to seven-year follow-up. J Arthroplasty. 1998;13:559–569.
Levinthal GS. Titanium, a metal for surgery. J Bone Joint Surg Am. 1951;33:473–474.
Lockey MW, Hahn GW, Corgill DA. Mandibular fractures: metallic implant fixation using vitallium mesh. Arch Otolaryngol. 1966;84:451–456.
Mowe JC. Standards for Tissue Banking. Arlington, VA: American Association of Tissue Banks; 1988.
Nehme A, Lewallen DG, Hanssen AD. Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res. 2004;429:201–208.
Nunez LV, Buttaro MA, Morandi A, Pusso R, Piccaluga F. Frozen sections of samples taken intraoperatively for diagnosis of infection in revision hip surgery. Acta Orthop. 2007;78:226–230.
Ornstein E, Franzen H, Johnsson R, Stefansdottir A, Sundberg M, Tagil M. Five-year follow-up of socket movements and loosening after revision with impacted morselized allograft bone and cement: a radiostereometric and radiographic analysis. J Arthroplasty. 2006;21:975–984.
Patel JV, Masonis JL, Bourne RB, Rorabeck CH. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty. 2003;18:129–133.
Piccaluga F, Gonzalez Della Valle A, Encinas Fernandez JC, Pusso R. Revision of the femoral prosthesis with impaction allografting and a Charnley stem: a 2- to 12-year follow-up. J Bone Joint Surg Br. 2002;84:544–549.
Roidis N, Karachalios T, Khaldi L, Stamos K, Lyritis GP. The role of stainless steel wire mesh and cement in bone allograft incorporation in impaction grafting technique: an experimental study in rabbits. J Arthroplasty. 2003;18:484–493.
Rosenberg WW, Schreurs BW, de Waal Malefijt MC, Veth RP, Slooff TJ. Impacted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis: an 8- to 18-year follow-up study of 36 hips. Acta Orthop Scand. 2000;71:143–146.
Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br. 1992;74:716–720.
Schnur DS, Lee D. Stiffness and inelastic deformation in acrylic titanium composite implant materials under compression. J Biomed Mater Res. 1983;17:973–991.
Schreurs BW, Bolder SB, Gardeniers JW, Verdonschot N, Slooff TJ, Veth RP. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup: a 15- to 20-year follow-up. J Bone Joint Surg Br. 2004;86:492–497.
Schreurs BW, Slooff TJ, Buma P, Verdonschot N. Basic science of bone impaction grafting. Instr Course Lect. 2001;50:211–220.
Schreurs BW, Slooff TJ, Gardeniers JW, Buma P. Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years’ experience. Clin Orthop Relat Res. 2001;393:202–215.
Schutzer SF, Harris WH. High placement of porous-coated acetabular components in complex total hip arthroplasty. J Arthroplasty. 1994;9:359–367.
Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty: sixteen-year-average follow-up. J Bone Joint Surg Am. 1997;79:159–168.
Silverton CD, Rosenberg AG, Sheinkop MB, Kull LR, Galante JO. Revision of the acetabular component without cement after total hip arthroplasty: a follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am. 1996;78:1366–1370.
Slooff TJ, Huiskes R, van Horn J, Lemmens AJ. Bone grafting in total hip replacement for acetabular protrusion. Acta Orthop Scand. 1984;55:593–596.
Slooff TJ, Schimmel JW, Buma P. Cemented fixation with bone grafts. Orthop Clin North Am. 1993;24:667–677.
Taitsman JP, Saha S. Tensile strength of wire-reinforced bone cement and twisted stainless-steel wire. J Bone Joint Surg Am. 1977;59:419–425.
Templeton JE, Callaghan JJ, Goetz DD, Sullivan PM, Johnston RC. Revision of a cemented acetabular component to a cementless acetabular component: a ten to fourteen-year follow-up study. J Bone Joint Surg Am. 2001;83:1706–1711.
Trancik TM, Stulberg BN, Wilde AH, Feiglin DH. Allograft reconstruction of the acetabulum during revision total hip arthroplasty: clinical, radiographic, and scintigraphic assessment of the results. J Bone Joint Surg Am. 1986;68:527–533.
van der Donk S, Buma P, Slooff TJ, Gardeniers JW, Schreurs BW. Incorporation of morselized bone grafts: a study of 24 acetabular biopsy specimens. Clin Orthop Relat Res. 2002;396:131–141.
van Haaren EH, Heyligers IC, Alexander FG, Wuisman PI. High rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg Br. 2007;89:296–300.
Welten ML, Schreurs BW, Buma P, Verdonschot N, Slooff TJ. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty: a 10- to 17-year follow-up study. J Arthroplasty. 2000;15:819–824.
Yoder SA, Brand RA, Pedersen DR, O’Gorman TW. Total hip acetabular component position affects component loosening rates. Clin Orthop Relat Res. 1988;228:79–87.
Author information
Authors and Affiliations
Corresponding author
Additional information
Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
About this article
Cite this article
Buttaro, M.A., Comba, F., Pusso, R. et al. Acetabular Revision with Metal Mesh, Impaction Bone Grafting, and a Cemented Cup. Clin Orthop Relat Res 466, 2482–2490 (2008). https://doi.org/10.1007/s11999-008-0442-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-008-0442-x