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Published on: August 4, 2022
Large acetabular defects can be managed with cementless revision components.
E Scott Paxton1, James A Keeney, William J Maloney
1Department of Orthopaedics, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, USA.
Clinical Orthopaedics and Related Research
|October 6, 2010
Summary
Cementless acetabular revision with bone grafting shows comparable midterm outcomes to other methods for major pelvic osteolysis. This technique offers potential for biological fixation and improved patient hip function.
Area of Science:
- Orthopedic surgery
- Biomaterials science
Background:
- Establishing optimal acetabular revision techniques for major pelvic osteolysis remains a challenge.
- Previous methods like bilobed components and reinforcement cages show significant midterm failure rates (10-24%).
- Cementless hemispherical components for large acetabular defects lack focused reports on extensive deficiencies.
Purpose of the Study:
- To evaluate midterm clinical outcomes, revision rates, and complications of focal bone grafting and cementless acetabular revision for major periacetabular osteolysis.
Main Methods:
- A cohort of 30 patients (32 hips) with massive acetabular bone loss underwent cementless acetabular revision.
- Follow-up averaged 53 months, with exclusions for loss to follow-up or early mortality.
- Clinical scores (Harris Hip Score) and radiographic outcomes (graft incorporation, component migration) were assessed.
Main Results:
- Mean Harris Hip Score improved significantly from 52.5 to 87.3.
- Revision for aseptic loosening occurred in 9% of hips; 10.7% showed radiographic migration without revision.
- Complete graft incorporation was observed in 68% of cases, with a 14% major complication rate.
Conclusions:
- Cementless acetabular fixation combined with bone grafting yields midterm clinical scores and survivorship comparable to alternative treatments.
- This approach presents a viable option with potential for biological fixation in managing extensive acetabular bone loss.