Abstract
Introduction
Severe acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. This acetabular deficienca occurs very often in Rheumatoid Arthritis.
In 1979 a biologic method was introduced with tightly impacted cancellous allograft in combination with a cemented polyethylene cup for acetabular reconstruction. With this technique it is possible to replace the loss of bone and restore hip function with a standard implant.
Because of the poor long term results and our own experience with large solid grafts we started in 1998 to use the impaction grafting in primary and revision hip replacements in Osteoarthritis and Rheumatoid Arthritis.
Materials and Methods
Between 1998 and 2001 35 acetabular reconstructions were performed in 29 patients with rheumatoid arthritis. 3 Patients were lost to follow up.
24 primary and 11 Revision Arthroplasties were performed. The average age was 55( 22-73. 29 female, 6 male.
58 Patients had additional dysplasia.
We had cavitary, segmental and also combined defects.
Femoral head autografts were used in all primaries, allografts were used in revision surgery.
Firstly the peripheral and central segmental defects were close with a metal mesh, so that only a cavitary defect remained. The cavity was filled with bone chips which were impacred layer by layer. To strabilize these reconstruction cement was used in direct contact with the graft.
In the Merle d’ Aubigne Score an improvement in pain, walking ability and function were observed. We had 1case of aseptic loosening, in a 73 year old female.
After 10 month the grafts were incorporated.
Our results are short term results- compared to the international literature ( Rosenberg et al. ) Nevertheless we can confirm the technique can be used with good results in cases with severe acetabular defects due to rheumatoid arthritis.
