Cementless acetabular reconstruction and structural bone-grafting in dysplastic hips

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Radiology

Background:

• Acetabular reconstruction in hip dysplasia often involves cement and bone grafts, but long-term data for cementless implants are scarce.
• Previous studies show increasing cup failure rates with cemented grafts in dysplastic hips post-total hip arthroplasty.
• This study addresses the limited data on long-term outcomes of bulk bone-grafting with cementless implants.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of autologous bulk bone-grafting combined with cementless acetabular cups.
• To determine the long-term survival rates of these reconstructions in patients with developmental dysplasia of the hip.

Main Methods:

• A prospective study followed 47 patients (56 hips) with developmental dysplasia of the hip from 1987 to 1992.
• Patients received structural autologous bulk bone grafts and cementless Harris-Galante type-I cups.
• Implant migration was assessed using single-image radiographic analysis in 55 hips over an average of 10.2 years.

Main Results:

• After an average of 10.2 years, eleven-year survival rates were 91.6% (revision) and 88.9% (loosening).
• Of 50 non-loosened implants, 14 showed measurable cup migration, with most being progressive.
• Survival at eleven years was 100% for implants without migration, but only 69.3% for those with migration (p = 0.0012).

Conclusions:

• Spherical press-fit cups with bulk bone-grafting demonstrate satisfactory eleven-year survival in complex acetabular reconstructions.
• Significant differences in survival were observed between migrated and non-migrated implants.
• Thirteen implants with progressive migration are at risk for future loosening, potentially increasing the revision rate.