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Cemented acetabular component with femoral neck autograft for acetabular reconstruction in Crowe type III dislocated
Eiji Goto1, Hirotsugu Umeda1, Makoto Otsubo1
1Department of Orthopaedic Surgery, Toyooka Chuou Hospital, Asahikawa, Japan.
Insights
This study shows that using a patient's own femoral neck bone graft with a cemented acetabular component offers good long-term outcomes for total hip arthroplasty in Crowe type III hip dislocations.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Bone Grafting
Background:
- Crowe type III hip dislocations present significant challenges in total hip arthroplasty due to large acetabular bone defects.
- Various surgical techniques exist, but long-term outcomes for anatomical reconstruction require evaluation.
Purpose of the Study:
- To evaluate the long-term clinical results of total hip arthroplasty in patients with Crowe type III dislocated hips.
- To assess the efficacy of using autologous bone graft from the femoral neck for acetabular reconstruction.
Main Methods:
- 28 total hip arthroplasties were performed on 22 patients with Crowe type III hip dislocations between 1979 and 2000.
- Autologous bone graft from the femoral neck was used to reconstruct the acetabulum before inserting a cemented acetabular component.
- Follow-up averaged 27.2 years for 21 hips in 18 patients.
Main Results:
- Bone grafts united successfully without collapse in all cases.
- The survival rate of the acetabular component, defined by mechanical loosening or revision, was 86.4% at 25 years.
- Only three acetabular components experienced mechanical loosening.
Conclusions:
- The described technique of using autologous femoral neck bone graft and a cemented acetabular component provides favorable long-term outcomes.
- This method is a viable option for anatomical reconstruction in Crowe type III dislocated hips.
- The study supports the use of this technique for achieving durable results in complex hip arthroplasty cases.
Aims:
Various surgical techniques have been described for total hip arthroplasty (THA) in patients with Crowe type III dislocated hips, who have a large acetabular bone defect. The aim of this study was to evaluate the long-term clinical results of patients in whom anatomical reconstruction of the acetabulum was performed using a cemented acetabular component and autologous bone graft from the femoral neck.
Methods:
A total of 22 patients with Crowe type III dislocated hips underwent 28 THAs using bone graft from the femoral neck between 1979 and 2000. A Charnley cemented acetabular component was placed at the level of the true acetabulum after preparation with bone grafting. All patients were female with a mean age at the time of surgery of 54 years (35 to 68). A total of 18 patients (21 THAs) were followed for a mean of 27.2 years (20 to 33) after the operation.
Results:
Radiographs immediately after surgery showed a mean vertical distance from the centre of the hip to the teardrop line of 21.5 mm (SD 3.3; 14.5 to 30.7) and a mean cover of the acetabular component by bone graft of 46% (SD 6%; 32% to 60%). All bone grafts united without collapse, and only three acetabular components loosened. The rate of survival of the acetabular component with mechanical loosening or revision as the endpoint was 86.4% at 25 years after surgery.
Conclusion:
The technique of using autologous bone graft from the femoral neck and placing a cemented acetabular component in the true acetabulum can provide good long-term outcomes in patients with Crowe type III dislocated hips. Cite this article: Bone Joint J 2021;103-B(2):299-304.
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