Reconstruction of acetabular deficiency utilizing iliac bone graft

ABSTRACT; Acetabular reconstructions were performed on 12 hips possessing deficient acetabuli. Eleven required total hip arthroplasties for relief of pain; seven of which were surface replacements. The one remaining h ip had erosion of the posterior wall, secondary to spastic paraparesis, and the posterior wall was reconstructed. The etiologies of the deficient acetabuli included five secondary to fracture/dislocation, four with acetabular dysplasias, and three related to failed acetabular components from conventional total hip arthroplasties. There were six posterior Hp deficiencies, five superior rim deficiencies, and one central deficiency. The iliac crest provided the graft material utilized in 11 of 12 cases; in one case the femoral head was used for reconstruction. All peripheral defects, however, were handled similarly regardless of the source of graft material, in that all grafts were secured with at least two cortical cancellous screws lagged for compression. Central defects utilized single cortex grafts keyed into the defect upon a bed of cancellous graft and rimmed with methyl methacrylate. All patients were followed at routine intervals; the shortest followup was 14 months, and the longest 32 months. All grafts showed radiographic evidence of union by one year. Three-phase bone scans were routinely done in patients undergoing surface replacement by one year. The scan appearance of the femoral head was identical to other uncomplicated surface replacements. The grafted area showed increased uptake.The purpose of this report is twofold: to present iliac crest as a graft material from which deficient acetabuli can be reconstructed when autogenous femoral head is not available, and to offer a fixation technique potentially less demanding and yet no less secure than those previously suggested. The results of this study indicate that, in selected situations, iliac crest graft acetabuloplasty can be successfully employed so that the total hip arthroplasties may be performed reducing fear of premature acetabular loosening related to insufficient bony coverage of the acetabular component.