Factors influencing the results of revised cemented sockets with bone grafting have been studied in 249 cases.

Freeze-dried allografts in 77 and fresh frozen in 172 cases have been used. The average follow-up was 8 years 11 months for the freeze-dried group and 2 years 11 months for the fresh frozen cases. There were 13 postoperative dislocations, 20 TNU, 4 thromboembolic complications, 4 delayed wound healing and 2 intraoperative fractures of the acetabulum. There have been 11 re-revisions: 8 for aseptic loosening, 2 for dislocation and 1 for infection. Radiographic evidence of loosening was seen in another 38 cases.

The acetabular bone stock at the time of revision and initial stability of socket fixation had a significant influence on the outcome. Direction of socket migration before surgery appeared to predict risk of failure. The primary pathology, type of bone graft and grafting technique also had an effect.

We previously reported the result of 45 Charnley LFA’s with femoral head autograft for Developmental Dysplasia of the hip with a minimum follow-up of ten years.

After an average follow-up of eleven years there was no revision. One socket migrated and four sockets were fully demarcated.

To assess our long-term results we reviewed the clinical and radiological findings in the same group of patients that had been studied previously.

To date 5 patients died from causes unrelated to the hip replacement and were excluded from the final radiological analysis. 40 Charnley LFA’s have been followed-up regularly.

The average follow-up is now 17 years 1 month / range: 15–21 years/. Three sockets have been revised: two for aseptic loosening and one for infection. Radiographic assessment showed that three sockets migrated and four had full demarcation.

Demarcation at the cement-bone interface of the socket was rare in zone one but was common in zone two.

We concluded that sound fixation of the autograft and orientations of the acetabular component are essential. We recommend that solid bone graft should be combined with impaction bone grafting in dysplastic cases. We also observed that bone grafting at primary surgery gives better chances for component fixation at the time of revision.