Hampus Stigbrand1, Oscar Gustafsson2, Gösta Ullmark1. 1. Department of Orthopaedic Surgery, Länssjukhuset Gävle, Sweden. 2. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Sweden; Department of Orthopaedic Surgery, Sunderby Sjukhus, Luleå, Sweden.
Abstract
BACKGROUND: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell. METHODS: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. RESULTS: Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent. CONCLUSION: IBG combined with the compressing shell results in excellent results for this challenging condition.
BACKGROUND: Treatment of acetabular bone loss with impaction bone grafting (IBG) at revision total hip arthroplasty is highly dependent on mechanical stability and graft compression for clinical success. Here, we describe a new technique to further compress and stabilize the acetabular graft bed with a thin, perforated titanium shell. METHODS: We retrospectively analyzed 170 cases of acetabular revision arthroplasty 7 years (standard deviation 2.8) after IBG combined with a graft-compressing titanium shell implant. The patients were reviewed by clinical score and radiography. Three patients were lost to follow-up. The medical journals of the 33 deceased cases were reviewed for any reoperation. Of the 170 cases, 74 had a cavitary acetabular bone defect, 93 had combined segmental and cavitary bone defects, and 3 had a pelvic dissociation. Bone graft incorporation was assessed and correction of the hip center of rotation was calculated. RESULTS: Five cases (3%) were reoperated for mechanical loosening. One more was assessed as loose but asymptomatic and was not planned for revision. There were 3 reoperations for recurrent dislocation, 2 for deep infection and 1 for technical error. Reoperation for any reason, as the end point of survivorship, showed a survival rate of 92% after 10 years. Hip score according to Merle, d'Aubigne, and Postel increased from 10.8 (preoperatively) to 16.4 at follow-up. The clinical and radiological results were excellent. CONCLUSION:IBG combined with the compressing shell results in excellent results for this challenging condition.
Authors: Tim Rolvien; Christian Friesecke; Sebastian Butscheidt; Thorsten Gehrke; Michael Hahn; Klaus Püschel Journal: Sci Rep Date: 2020-09-16 Impact factor: 4.379