Histological Analysis of Acetabular Bone Impaction Grafting According to Slooff 15 Years After Implantation

We describe the case of a 78-year-old multimorbid male patient with a history of right-sided total hip arthroplasty in 1996 and homologous acetabular bone graft reconstruction according to Slooff in 2009. In December 2024, the patient presented with acute right hip pain due to acute on chronic loosening of the implant. Diagnostic workup revealed a low-grade periprosthetic joint infection with Cutibacterium acnes. After preoperative optimization, the patient underwent implant explantation and conversion to a Girdlestone state. Histological analysis of the explanted Slooff augment showed nonvital and nonincorporated cancellous bone, lacking osteocytes within the bone lacunae, indicating the absence of viable bone and remodeling.

Reconstruction of acetabular defects, particularly in cases of severe bone loss or medial wall protrusion, remains a significant challenge in revision total hip arthroplasty (rTHA). The Slooff technique, involving morselized homologous bone grafts impacted into the acetabular defect and stabilized with a cemented cup, has been widely adopted for such cases due to its relative simplicity and promising midterm outcomes. However, the biological and mechanical long-term integration of such constructs, as observed in this case, remains a topic of ongoing debate.