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Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device with bone allograft: minimum
H Akiyama1, K Yamamoto, M Tsukanaka
1Kobe City Medical Center General Hospital, Department of Orthopaedics, 4-6, Minatojimanakamachi, Chuo-ku, Kobe-City, Hyogo 650-0046, Japan. hakiyama@kuhp.kyoto-u.ac.jp
Insights
Revision total hip replacement using the Kerboull acetabular reinforcement device with bone allografts shows satisfactory mid-term outcomes. This study highlights the importance of structurally sound allografts for successful acetabular reconstruction.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Radiology
Background:
- Acetabular defects in revision total hip replacement pose significant challenges.
- The Kerboull-type acetabular reinforcement device with bone allografts is a surgical option for complex acetabular reconstruction.
- Management strategies vary based on the American Academy of Orthopaedic Surgeons (AAOS) defect classification.
Purpose of the Study:
- To evaluate the mid-term clinical and radiological outcomes of acetabular reconstruction using the Kerboull device with bone allografts.
- To assess the impact of allograft type and defect classification on surgical success.
- To provide evidence-based recommendations for allograft selection and preparation.
Main Methods:
- Retrospective review of 40 hips in 36 patients undergoing acetabular reconstruction with a Kerboull device and bone allografts.
- Classification of defects according to AAOS Type II and Type III.
- Analysis of radiological failure, Merle d'Aubigné scores, and Kaplan-Meier survival rates.
- Experimental analysis of mechanical properties of the device and bone grafts.
Main Results:
- Five hips (12.5%) experienced radiological failure at a mean follow-up of 6.7 years; two of these were infected.
- The mean Merle d'Aubigné score improved from 10 pre-operatively to 13.6 post-operatively.
- The 10-year Kaplan-Meier survival rate was 87%, with radiological failure or revision as endpoints.
- Structurally hard allografts from osteoarthritic femoral heads are recommended; bone graft thickness < 25 mm is acceptable for Type II defects with impacted grafts.
Conclusions:
- Revision total hip replacement using the Kerboull-type acetabular reinforcement device with bone allografts demonstrates satisfactory mid-term results.
- The choice of structurally robust allografts is crucial for successful acetabular reconstruction.
- This technique offers a viable solution for managing significant acetabular defects in revision hip arthroplasty.
Abstract:
We retrospectively reviewed 40 hips in 36 patients who had undergone acetabular reconstruction using a titanium Kerboull-type acetabular reinforcement device with bone allografts between May 2001 and April 2006. Impacted bone allografts were used for the management of American Academy of Orthopaedic Surgeons Type II defects in 17 hips, and bulk bone allografts together with impacted allografts were used for the management of Type III defects in 23 hips. A total of five hips showed radiological failure at a mean follow-up of 6.7 years (4.5 to 9.3), two of which were infected. The mean pre-operative Merle d'Aubigné score was 10 (5 to 15) vs 13.6 (9 to 18) at the latest follow-up. The Kaplan-Meier survival rate at ten years, calculated using radiological failure or revision of the acetabular component for any reason as the endpoint, was 87% (95% confidence interval 76.3 to 97.7). A separate experimental analysis of the mechanical properties of the device and the load-displacement properties of bone grafts showed that a structurally hard allograft resected from femoral heads of patients with osteoarthritis should be preferentially used in any type of defect. If impacted bone allografts were used, a bone graft thickness of < 25 mm was acceptable in Type II defects. This clinical study indicates that revision total hip replacement using the Kerboull-type acetabular reinforcement device with bone allografts yielded satisfactory mid-term results.