Abstract
Purpose: The purpose of revision surgery for a hip arthroplasty is to re-establish a stable assembly, recover bone stock, and re-establish the mechanical centre of the joint. The purpose of our work was to evaluate clinical and radiographic mid-term outcome of a press-fit cup on bone grafts for cup revision of total hip arthroplasty (THA).
Material and methods: We revised 55 hip arthroplasties in 1995 and 1996, for revision of the cup with reconstruction in 42 cases. For 16 patients (ten women and five men), we used the press-fix technique on bone grafts. Mean patient age was six years (range 34–82) and mean follow-up was 70 months (range 62–86). Besides four partial arthroplasties, the revised components were six screwed cups, five cemented cups and one press-fit cup. The reason for the first intervention was hip degeneration in most of the patients. We used the posterior approach in all patients. Bone bank stock was used, ground in fifteen cases and structured in two. Thirteen cups were coated with hydroxyapatite, three with a porous coating. Four components were reinforced with screws. We evaluated bony defects with the Paproski classification. The clinical aspect was assessed with the
Postel-Merle-d’Aubigné scale. For the radiographic analysis, we considered the situation of the implant after revision and possible later displacement. For the graft tissue, we studied integration in the De Lee-Charnley zones.
Results: None of the cups required revision. The component was well integrated in 62.5% of the patients. Function score improved from 11.5/18 preoperatively to 15/18 postoperatively then 15.9/18 at last follow-up. Subjectively patient satisfaction was good or excellent in 81% of the cases.
Discussion: This technique reinforces the bone stock since it preserves the bone present and adds new bone, facilitating integration. Likewise, it does not require changing the functional centre of the hip, good integration of the implant favours good assembly. Functional and subjective outcomes are good.
Conclusion: After at least six years follow-up, press-fit bone grafting for revision procedures is a promising technique.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
