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Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results
R A Berger1, J J Jacobs, L R Quigley
1Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.
Insights
Cementless acetabular reconstruction shows excellent long-term survival in patients under 50. While radiographic loosening is absent, polyethylene wear and osteolysis are concerns over time.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
Background:
- Acetabular reconstruction is crucial for hip joint function.
- Younger patients (<50 years) present unique challenges for hip implant longevity.
Purpose of the Study:
- To evaluate the efficacy and long-term outcomes of cementless acetabular reconstruction in patients younger than 50.
- To assess implant survival rates, radiographic stability, and the incidence of osteolysis.
Main Methods:
- Analysis of 79 consecutive cementless, hemispheric, porous-coated acetabular reconstructions (Harris-Galante-I).
- Average patient age at surgery: 37 years (range 20-49).
- Average follow-up: 106 months (range 78-126 months).
Main Results:
- No acetabular reconstructions revised for aseptic loosening; 98.8% 10-year survival rate.
- Excellent radiographic stability observed in all 72 acetabular reconstructions at final follow-up.
- Acetabular osteolysis occurred in 7.4% of cases, primarily linked to polyethylene wear and inversely related to patient age.
Conclusions:
- Cementless acetabular reconstruction demonstrates excellent intermediate results in younger patients, with no radiographic loosening.
- Osteolysis emerges as the most common complication, increasing with duration of implantation and polyethylene wear.
- Further research into wear-resistant materials is warranted to mitigate long-term osteolysis risks in this demographic.
Abstract:
The efficacy of primary cementless acetabular reconstruction in patients younger than 50 years of age was analyzed in 79 consecutive cementless, hemispheric, porous coated acetabular reconstructions (Harris-Galante-I). The average age was 37 years at surgery (range, 20-49 years). The average followup was 106 months (range, 78-126 months). No acetabular reconstructions were revised for aseptic loosening. Two stable acetabular reconstructions were revised during femoral revision. Two excessively worn polyethylene liners were exchanged and one acetabular osteolytic area was debrided and grafted; these procedures retained the metal shell. At final followup, all 72 acetabular reconstructions were radiographically stable. Acetabular osteolysis occurred in five cases (7.4%), from 84 to 104 months. Acetabular or femoral osteolysis occurred in patients with increased polyethylene wear. Polyethylene wear was inversely related to the patient's age. Using revision and loosening, the Kaplan-Meier 10 year survival of the acetabular reconstruction was 98.8% (95% confidence interval, 96.6%-100.%). The intermediate results of cementless, hemispheric, porous coated acetabular reconstruction in younger patients was excellent with no radiographic loosening. At 7- to 11-year followup, osteolysis was the most common problem and increased in frequency and extent with continued in vivo duration.