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Structural bone grafting in arthroplasty for congenital hip dysplasia: 35 hips followed for 5-10 years
R Becker1, D Urbach, H Grasshoff
1Orthopädische Universitätsklinik, Otto von Guericke Universität Magdeburg, Germany. Roland.Becker@medizin.uni-magdeburg.de
Insights
This study on hip arthroplasty for hip dysplasia found that bone graft resorption occurred over time, reducing acetabular component coverage. However, clinical outcomes improved significantly, with only one revision needed.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Radiology
Background:
- Secondary osteoarthrosis due to congenital hip dysplasia presents complex reconstructive challenges.
- Acetabular component fixation in hip arthroplasty can be compromised by bone stock deficiencies.
Purpose of the Study:
- To evaluate the long-term efficacy and radiographic changes of using autologous femoral head grafts in acetabular reconstruction for hip dysplasia.
- To assess graft resorption, component coverage, and clinical outcomes following this surgical technique.
Main Methods:
- Retrospective analysis of 35 hip arthroplasties in 30 patients with congenital hip dysplasia.
- Utilized autologous femoral head grafts for acetabular augmentation, assessing initial and 7-year follow-up radiographic parameters.
- Evaluated clinical outcomes using the Harris Hip Score and noted revision rates.
Main Results:
- Initial 100% acetabular component coverage was achieved, with grafts providing 34% mean support.
- Significant graft resorption (29% decrease) occurred over 7 years, reducing cup coverage to 94%.
- Harris Hip Score improved from 37 to 85 points; no correlation found between graft size and clinical outcome. One revision due to dislocation.
Conclusions:
- Autologous femoral head grafts provide initial acetabular support but undergo significant resorption over time.
- Despite resorption, hip arthroplasty using these grafts leads to substantial clinical improvement in patients with hip dysplasia.
- Graft resorption primarily affects non-contact areas, and the technique demonstrates acceptable long-term clinical results with a low revision rate.
Abstract:
We assessed 35 hip arthroplasties in 30 patients with an average follow-up of 7 years. All patients suffered from secondary osteoarthrosis due to congenital dysplasia. The mean age at the time of surgery was 54 (19-77) years. Part of the femoral head used as a graft was fixed to the superolateral region of the acetabulum. A 100% bone coverage of the acetabular component was achieved initially. The mean support by the graft was 34%. The graft size, measured in the AP view, decreased on average 29% after 7 years. The resorption caused a reduction in cup coverage to 94%. There was no correlation between the clinical outcome and the graft size. Graft resorption occurred in the horizontal and vertical axes, but hardly affected the contact region with the iliac bone. Radiolucent lines according to DeLee were found in zone I in 4, zone II in 6 and zone III in 7 cases. The Harris Hip Score improved from 37-85 points. 1 revision was necessary 7 months postoperatively after cup dislocation.
