Morselized homologous grafts in revision arthroplasty of the acetabulum

Because they show fairly good short- and mid-term results frozen, morselized homologous bone grafts have become very popular in acetabular reconstruction after failed total hip arthroplasty. Graft integration proceeds uneventfully. However, very little is known about its longevity. From 1980 to 1984 we performed 121 acetabular revisions in cases with contained bone defects utilizing homologous bone graft and a cementless non-coated or hydroxyapatite coated HDPE cup. At the end of 1991 (7 to 11 years after the operation), 43 patients (35%) were available for review. 41 patients (34% had died, 19 patients (16%) were lost to follow-up. In 18 patients (15%), the cups had been revised because of aseptic loosening. The Harris Hip Score showed 50% good to excellent results. Cups inserted after grafting of cystic defects showed almost no migration. However when cavity defects were filled with large bone grafts (n = 23), slow continuous cup migration and progressive graft resorption over time was observed. Due to this continuous resorption, we conclude, that morselized bone grafts do not guarantee an ever lasting inert interface. Once the non-coated HDPE cup is in contact with the autogenous host bed, bone osteolysis occurs and loosening proceeds. Cementless porous coated cups with morselized allografts alone may be used in acetabular revision only when cystic defects are present. The surface of the cup has to be brought into contact with a well vascularized autochthonous pelvic bone in order to achieve stable fixation. Segmental and massive cavity defects can only be reconstructed with morselized allografts when protected from loading by supporting rings.(ABSTRACT TRUNCATED AT 250 WORDS)