O2515 WHOLE ACETABULAR ALLOGRAFTS: 12 YEARS EXPERIENCE

Abstract

Introduction: One of the greatest challenges in the actual Orthopaedic Surgery is how to reconstruct with a certain long-therm efþcacy the severe acetabular defects in hip revision. AWholeAcetabularAllograft represents a human tissue of good quality, (donor age under 40 years), that keeps the original trabecular stucture with a 100% adaptation to host bone. Material & method: We perform acetabular reconstructions according to our own so called ÒICATME Classiþcation of Acetabular Defects: Type I: Cavitary Defects. Cup. Type II: Simple columnar Defect. Type III: Complexe Columnar Defect. Type IV: Pelvic Discontinuity. From 1988 up to January 2001 we have performed 44 acetabular reconstructions with whole acetabulum allografts. Follow up ranging from 2 to 12 years (Mean: 7,2 years). Mean patient age: 58,6 years. Evaluation includes clinical examination (Merle DñAubigne Score for Gait and Pain) and radiological measurements according to the Engh Criteria (Engh-Massin-Southers, JBJS, 1994) Results: Radiological consolidation was achieved in 33 from the 35 cases (94,2%). There were 3 infections during the þrst year. One infection was solved by a 1 stage THA replacement with antibiotic-loaded cement (Endoklinik, Hamburg; the allograft was refreshed and mantained) and 2 by Girldestone procedure. In 7 cases (20%) there was a marked bone resorption with loosening of the acetabular component and screws ruptures. From these 7 cases 4 occurred 5 years after reconstruction. In all these cases the allograft was consolidated and it only needed to be refreshed before to insert into it a new cemented acetabular cup. No more acetabular reconstruction was necessary. According to the Kaplan-Meierñs Curves the predictive survival rate is 72% at 10 years, while it is 87,5% at 5 years and 78,2 at 8 years. There is a highly marked improvement in Merle DñAubigne Score. Gait paramether: 2,2 preoperative Ð 5,4 at follow-up. Pain paramether: 2,5 preoperative Ð 4,9 at follow-up. Conclusions: Whole Acetabulum Allograft have an excellent bone quality, intact and identical trabeculation, 100% adaptability. Survival Rate of 72% at 10 years with the added advantatge that all failured cases could be solved without any further acetabular reconstruction. these patients to keep a good clinical-functional score.•. We have obtained a very good result in pelvis discontinuities. We think this is a method to consider it as highly efþcient for these cases.