Abstract
The main object of acetabular revisions is to restore bone stock and provide adequate support for the cup. Allograft bone has been used to reconstruct the acetabulum with variable results. This study is a prospective assessment of the performance of the uncemented cups with morsellized allograft bone in revision acetabular reconstruction.
A single surgeon using a direct lateral approach performed 98 acetabular revisions. An uncemented hemispherical cup with multiple screw holes and morsellized allograft bones was used in all the reconstructions. Patients were clinically assessed by Harris Hip score. Acetabular defects were classified by AAOS Classification system using standard AP pelvis x-rays. Massin’s criteria was used for assessing cup migration; evidence of screw breakage and acetabular bone incorporation were also looked for.
5 patients died before the 3-year follow-up, leaving 93 hips for final analysis. Mean age at surgery was 66 years (range 24–87). Majority of the acetabular defects belonged to AAOS type III. The mean follow-up was 76. 13 hips have undergone repeat revisions, five of which for aseptic loosening of the cup. Meantime to revision was 42 months.
Reconstruction of the bone-deficient acetabulum in revision arthroplasty of the hip is a difficult problem and no single procedure is universally good. However, the use of allograft bone provides a biological solution by restoring the bone stock. The use of uncemented cups with screws provides the primary stability that is supplemented later by the incorporated allograft bone. The rate of revisions for aseptic loosening of the cup in our series is low at 6% after a mean of 6 years. Even in these cases the repeat revisions were significantly easier due to restored bone stock.
The abstracts were prepared by Mr Simon Donell. Correspondence should be addressed to him at the Department of Orthopaedics, Norfolk & Norwich Hospital, Level 4, Centre Block, Colney Lane, Norwich NR4 7UY, United Kingdom.
