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Hip

CEMENTED HIP REVISION FOR ASEPTIC CUP LOOSENING USING STRUCTURAL ACETABULAR ALLOGRAFT. CLINICAL AND RADIOLOGICAL FOLLOW-UP TO 22 YEARS

British Hip Society meeting (BHS) March 2016



Abstract

Introduction

Large acetabular bone defects caused by aseptic loosening are common. Reconstruction of large segmental defects can be challenging. Various implants and operative techniques have been developed to allow further acetabular revision in cases where bone stock is poor. Reconstitution of bone stock is desirable especially in younger patients. The aim of the study was to review the clinical and radiological results of hip revision with structural acetabular bone grafts using fresh frozen allograft and cemented components.

Method

Between 1990 and 2014, 151 first time revisions for aseptic acetabular loosening with acetabular reconstruction with a fresh frozen structural allograft and cemented components were performed at our hospital.

Graft dimensions, number of screws used and socket coverage by the graft were measured on the post-operative AP radiograph.

Follow-up radiographs were analysed for socket loosening, quality of graft union, graft and graft resorption.

Results

At a mean follow-up of 7 years 11 months (range 0 – 22), 5 patients had died and 24 hips revised (15.9%). One hundred and three hips had a follow-up greater than 5 years. The reasons for re-revision were infection in 1, recurrent dislocation in 4, aseptic stem loosening in 4 and aseptic cup loosening in 21 (13.9%). Survival analysis with revision for aseptic cup loosening as the endpoint was 80.2% at 10 years.

Conclusion

The results using solid allograft to reconstruct the acetabulum are encouraging with a follow-up to 22 years. Structural allograft is a good option to reconstruct segmental defects of the acetabulum at revision surgery and we especially advocate its use to reconstitutes bone stock in younger patients.