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Bone grafting in total hip arthroplasty for insufficient acetabulum
T Xenakis1, T Koukoubis, K Hantes
1Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Greece.
Insights
Total hip arthroplasty (THA) with autologous bone grafts shows promise for congenital hip disease (CDH). Ceramic cups demonstrated superior bone graft consolidation and fewer revisions compared to titanium cups in THA for CDH patients.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Congenital disease of the hip (CDH) presents unique challenges for total hip arthroplasty (THA).
- Autologous bone grafting is a potential adjunct for enhancing THA fixation in complex cases.
Purpose of the Study:
- To evaluate the effectiveness of THA supplemented with autologous bone grafts in CDH patients.
- To compare the outcomes of ceramic versus titanium acetabular cups in conjunction with bone grafting.
Main Methods:
- Two groups of CDH patients underwent cementless THA: Group A (n=33) with ceramic cups (Autophor) and Group B (n=85) with titanium cups (CST).
- Autologous bone grafts were applied via cotyloplasty, bone chips, or corticocancellous grafts.
- Follow-up averaged 11 years (Group A) and 9 years (Group B).
Main Results:
- All grafts in Group A (ceramic cups) consolidated by 6 months, with only 2 partial absorptions and 2 non-graft-related revisions.
- In Group B (titanium cups), 63/85 grafts consolidated; 4 intrapelvic grafts showed absorption, leading to 3 cup revisions due to graft absorption.
- Ceramic cups showed superior bone graft consolidation and fewer revisions than titanium cups.
Conclusions:
- Autologous bone grafts are effective adjuncts for THA fixation in CDH patients.
- Threaded ceramic acetabular cups are superior to threaded titanium cups for THA in CDH, regarding bone graft consolidation and revision rates.
Abstract:
We assessed the effectiveness of total hip arthroplasty (THA) supplemented with autologous bone grafts in patients with congenital disease of the hip (CDH). 2 groups of patients were evaluated: In Group A, 33 patients with a mean age of 54 years underwent arthroplasties using a threaded ceramic conical acetabular cup without cement (Autophor). In Group B, 85 patients with a mean age of 55 years underwent arthroplasties using a threaded, noncemented, titanium cup (CST). Bone grafts were supplemented the THA in 3 ways: 1) intrapelvic application using the cotyloplasty technique, 2) as bone chips in order to cover small defects around the upper and lateral part of the cup, and 3) as a bulky corticocancellous graft which was secured with screws. Follow-up averaged 11 and 9 years for patients in Groups A and B, respectively. All the grafts in Group A had consolidated by the end of 6th month. Only 2 partial absorptions were observed, 1 intrapelvic graft and 1 corticocancellous graft. 2 revisions were performed in this group of patients, but neither were related to bone graft absorption. By the end of 6 month, 63 of 85 in Group B had consolidated bone grafts. In 16 patients with intrapelvic cotyloplasty, 3 demonstrated complete and 1 partial absorption of the grafts. 3 cup revisions were performed in this group of patients, all with complete graft absorption. Our findings indicate that autologous bone grafts are strong adjunct for satisfactory fixation of THA in patients with CDH, a particularly demanding group of patients to manage. In addition, the ceramic threaded cup was found to be superior to the titanium threaded cup in terms of both bone graft consolidation and the number of revisions required.