Long-term outcome of shelf grafts in total hip arthroplasty for developmental hip dysplasia

Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental hip dysplasia is often complex due to anterolateral acetabular bone deficiency. The use of femoral head (shelf) autograft during the index arthroplasty provides nonimmunogenic, osteoconductive support with the potential for enhanced bone stock should revision surgery be required. Few long-term studies document the outcome of the use of shelf grafts in primary THA or quantify the need for further bone graft at revision surgery. A retrospective analysis was conducted of a single surgeon's series of 31 THAs performed in 25 patients with developmental hip dysplasia. Postoperative biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range, 8-18 years). Grafts were assessed for union, resorption, and displacement. The need for acetabular bone graft at revision surgery was recorded. Bony union was observed in 93% of cases; fibrous union developed in the remaining 7%. There was no graft displacement. In 71% of cases, less than one-third of the graft had resorbed; one-third to one-half had resorbed in the remaining 29% of cases. Of 10 patients revised (all for loosening of the acetabular component), 2 required structural allograft for inadequate bone stock. Femoral head autograft allows effective acetabular coverage with excellent rates of union, exhibits minimal graft resorption in the long-term, and rarely requires further acetabular allograft in revision surgery.