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6 years follow-up of hip revision surgery
1Elias Universitary Hospital, Bucharest, Romania. horiabogdan@live.com
Insights
Bone grafting effectively restores bone stock in revision hip arthroplasty for acetabular defects. Uncemented stems are preferred for severe bone loss with poor cementation.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Revision total hip arthroplasty frequently involves significant bone loss.
- Managing acetabular bone defects is a critical challenge in revision hip surgery.
Purpose of the Study:
- To evaluate the outcomes of hip revision surgery based on bone stock.
- To assess the efficacy of bone grafting and implant choices in addressing bone loss.
Main Methods:
- Retrospective study of 148 hip revision surgeries (2004-2010).
- Clinical and radiological assessment using Harris Hip Score (HHS), acetabular cementation, AAOS classification, SOFCOT 99 grading, and Barrack classification.
Main Results:
- Significant improvement in HHS from 45 preoperatively to 77.2 postoperatively.
- Acetabular allografts were associated with Grade B cementation.
- Barrack grades C and D cementation correlated with advanced SOFCOT 99 stages (III-IV).
Conclusions:
- Bone grafting is a reliable method for restoring bone stock and cup stability in AAOS type II-IV acetabular defects.
- Uncemented, distally fixed revision stems are recommended for SOFCOT 99 stages III-IV due to poor cementation.
Abstract:
Revision total hip arthroplasty often presents surgeons with difficult bone loss problems. The purpose of this study was to evaluate the results of hip revision surgery according to bone stock We evaluated, in a retrospective study, 148 hip revision surgeries during 2004 to 2010. The Harris Hip Score (HHS), the acetabular cementation, the AAOS classification, the SOFCOT 99 bone loss grading and Barrack classification were used for clinical and radiological assessment. It can be observed significant improvement of HHS from a mean value of 45 preoperatively to 77.2 points postoperatively. Grade B acetabular cementation was observed in a significantly higher rate for situations that needed acetabular allograft reconstruction and where it cannot be performed because of allografts lack. Barrack grades C and D cementation were associated with 70% of SOFCOT 99 stage III and IV cases and only 5% of SOFCOT 99 stage 0-II cases.Using bone graft seems to be a reliable solution for restoring bone stock and stabilizing the cup in revision total hip arthroplasty with type II-IV acetabular defect according to the AAOS classification. Because SOFCOT 99 stages III-IV are often associated with poor cementation we prefer using uncemented distally fixed with screws revision stems for these cases.
