Bone Morphogenetic Proteins-2-Augmented Acetabular Bone Stock Restoration During Two-stage Revision for...

Severe acetabular bone loss in the setting of Periprosthetic Joint Infection (PJI) presents a significant reconstructive challenge, particularly in biologically compromised environments where conventional graft incorporation may be unreliable. Bone Morphogenetic Proteins (BMPs) are potent osteoinductive agents, but their role in post-infective acetabular reconstruction remains limited.

We report the case of a 34-year-old male with sickle cell disease who presented with chronic infection and loosening of a total hip arthroplasty, associated with severe acetabular bone loss (Paprosky IIIA). A two-stage revision strategy was employed. During the first stage, following implant removal and extensive debridement, the acetabular defect was reconstructed using a composite graft consisting of morselized allograft, antibiotic-loaded calcium sulfate, bone marrow aspirate, and recombinant human BMP-2. Radiological evaluation at 3.5 months demonstrated robust graft consolidation and restoration of the medial acetabular wall. After confirmation of infection eradication, second-stage reimplantation was successfully performed using a porous acetabular component with stable fixation.

This case demonstrates that adjunctive use of BMP can facilitate biologic restoration of acetabular bone stock in complex PJI scenarios, enabling effective reconstruction during staged revision arthroplasty. While promising, the use of BMP in this setting remains off-label and warrants careful patient selection, with further studies needed to establish its safety and efficacy.