The Biological Approach in Acetabular Revision Surgery: Impaction Bone Grafting and a Cemented Cup

Impaction bone grafting is a useful technique in the armament of a revision hip surgeon. Traditionally fresh frozen allograft has been used for this technique. However there are concerns about the transmission of viral proteins and prions through this form of allograft. As a result irradiated bone graft has been favoured in some centres. There is no long term series describing the results of impaction bone grafting using irradiated bone. This paper reviews a consecutive series of 50 cases of acetabular revision surgery performed between 1995 and 2001 and followed up over a mean period of 45 months. The preoperative bone defect was graded by the Paprosky classification. There were 2 cases of type 1a, 9 type 2a, 15 type 2b, 7 type 2c, 10 type 3a and 7 type 3b. All cases were followed up clinically and radiologically. Case notes were reviewed for primary prosthesis, operative details and reason for revision. The radiographs were evaluated for signs of bone incorporation, remodelling, loosening and migration of the acetabular component. There were 5 cases of aseptic loosening at the end of the follow up period. One patient had recurrent dislocation and was revised. 20 cases (40%) showed changes suggestive of bone incorporation, while only 3 cases (6%) showed remodelling. Clinically a good or excellent outcome with absence of pain was achieved in 35 patients (70%). The results suggested that acetabular impaction bone grafting using irradiated bone graft is comparable to fresh frozen allograft. The low percentage of remodelling remains a concern and warrants further studies.

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Acetabular Revision with Metal Mesh, Impaction Bone Grafting, and a Cemented Cup

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-008-0442-x ◽

2008 ◽

Vol 466 (10) ◽

pp. 2482-2490 ◽

Cited By ~ 68

Author(s):

Martín A. Buttaro ◽

Fernando Comba ◽

Rodolfo Pusso ◽

Francisco Piccaluga

Keyword(s):

Bone Grafting ◽

Acetabular Revision ◽

Impaction Bone Grafting ◽

Metal Mesh ◽

Cemented Cup

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Impaction bone grafting in hip re-revision surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1228.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 492-499

Author(s):

Eduardo Garcia-Rey ◽

Laura Saldaña ◽

Eduardo Garcia-Cimbrelo

Keyword(s):

Aseptic Loosening ◽

Acetabular Component ◽

Revision Surgery ◽

Bone Grafting ◽

Bone Defects ◽

Bone Stock ◽

Impaction Bone Grafting ◽

Acetabular Bone ◽

Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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Impacted Morsellised Allograft and Cemented Cup in Acetabular Revision Surgery. A Five to Nine Year Follow-Up Study

Hip International ◽

10.1177/112070000201200303 ◽

2002 ◽

Vol 12 (3) ◽

pp. 281-288 ◽

Cited By ~ 14

Author(s):

E. Garcia-Cimbrelo ◽

J. Cordero

Keyword(s):

Revision Surgery ◽

Acetabular Revision ◽

Cumulative Probability ◽

Acetabular Bone ◽

Radiolucent Lines ◽

Frequent Use ◽

Acetabular Bone Defect ◽

Metallic Mesh ◽

Cemented Cup

Seventy cemented cups associated with impacted morsellised allograft in revision surgery in hips with an acetabular bone defect greater than 30% (Paprosky Grades 3A and 3B) were analyzed. The mean follow-up was 6.8 years. One hip showed cup migration and was re-revised; this represents a total cumulative probability of re-revision of the cup of 1.4 ± 2.8%. Radiolucent lines were uncommon: six cups showed radiolucent lines in DeLee and Charnley zone 1, five in zones 1 and 2, one in all three zones, while one hip showed migration. Although the frequent use of a metallic mesh makes graft remodeling difficult to evaluate, six hips showed minor and one major bone resorption. The midterm results with impacted allograft and cemented all-polyethylene cups are favourable in acetabular revision surgery.

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