Acetabular reconstruction with impacted morselized cancellous allografts in cemented hip arthroplasty: a histological...

Bone defects in total hip arthroplasty revision surgery can be restored with different types of bone graft. The use of impacted morselized allograft chips in combination with cement is the treatment of our choice. To establish the incorporation capacity of the grafts and mechanical stability of the implant, an animal model in the goat was developed. An acetabular defect was created and restored with morselized grafts and a cemented cup. Postoperative performance of the reconstruction was followed both histologically and biomechanically. Histology showed that consolidation of the graft with the host bone bed had occurred within 3 weeks. In the following period a front of vascular sprouts infiltrated the graft. Graft resorption, woven bone deposition, and subsequent remodeling resulted in a new trabecular structure. This structure contained only scarce remnants of the original dead graft material. At the graft-cement interface, graft resorption and new bone formation had resulted in areas of direct vital bone-cement contact. Locally, a soft tissue interface was present. After longer follow-up periods, progressive interface formation and loosening of the cups were found in most animals. Mechanical testing showed that the stability of the reconstruction increased during the first 12 postoperative weeks. Thereafter, the stability decreased, probably by soft-tissue interface formation at the graft cement interface. We conclude that cemented morselized allografts have a high capacity to incorporate. Initial cup stability is adequate to provoke graft incorporation with decreasing stability after the incorporation process has been completed.