We report intermediate term results of a technique of acetabular augmentation using block femoral head autograft and the uncemented expansion cup for adult hip dysplasia. A retrospective review of one surgeon (BFH) series of consecutive total hip replacements for hip dysplasia using femoral head acetabular augmentation was carried out. The technique involves sectioning the femoral head longitudinally reversing and fixing it to the deficient acetabulum with 6.5mm AO screws. This is then reamed to accept the uncemented expansion cup. Patients were identified from audit databases. Patients completed clinical questionnaires, examination and radiographic evaluation. Fifteen hips were identified in twelve patients (three bilateral). The average at age at surgery was 54 (44–58) years. There were eight females (eleven hips). Three patients (three hips) were unable to be contacted. Average follow up was 8.4 (4.8–11.4) years. Preoperative centre edge angle was 14 (−10–30) degrees. One patient developed a deep infection requiring early staged revision. One patient was not satisfied with her results at follow up. Mean Harris Hip Score was 83 (63–100), mean WOMAC Score was 76 (50–95). Range of motion was well maintained in all patients. Four patients had other co-morbidities affecting their results. Radiological review shows all grafts to have united with no screw breakage and no cup loosening. At eight year follow up there is high satisfaction, good clinical and radiological results. These results demonstrate good intermediate term results using this technique in total hip replacement with acetabular dysplasia

We previously reported the result of 45 Charnley LFA’s with femoral head autograft for Developmental Dysplasia of the hip with a minimum follow-up of ten years. After an average follow-up of eleven years there was no revision. One socket migrated and four sockets were fully demarcated. To assess our long-term results we reviewed the clinical and radiological findings in the same group of patients that had been studied previously. To date 5 patients died from causes unrelated to the hip replacement and were excluded from the final radiological analysis. 40 Charnley LFA’s have been followed-up regularly. The average follow-up is now 17 years 1 month / range: 15–21 years/. Three sockets have been revised: two for aseptic loosening and one for infection. Radiographic assessment showed that three sockets migrated and four had full demarcation. Demarcation at the cement-bone interface of the socket was rare in zone one but was common in zone two. We concluded that sound fixation of the autograft and orientations of the acetabular component are essential. We recommend that solid bone graft should be combined with impaction bone grafting in dysplastic cases. We also observed that bone grafting at primary surgery gives better chances for component fixation at the time of revision

Developmental Hip Dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Autogenous bulk grafting using the femoral head has been utilised to achieve anatomic cup placement and superolateral bone coverage in these patients, but reported outcomes on this technique have been mixed with lack of graft integration and subsequent collapse seen as an early cause of failures. Achieving union and incorporation of the autogenous graft have been identified as key determinants of a successful outcome with this technique. The main factors affecting incorporation are stability of the construct and host-graft bone contact. We describe a novel technique combining the use of bulk autograft with an iliac osteotomy, which provides primary stability and optimises direct cancellous-cancellous bone contact.

21 hips in 21 patients with DDH underwent this technique and were followed for a mean 8.1 years. The pre-operative radiographic classification was Crowe type I in 12 hips (57%), type II in 4 hips, and type III in 5 hips, and the mean Sharp angle was 49.6° (range 42–60°). All grafts united by year. At time of follow up, there was no radiographic evidence of graft collapse or loosening. There were no reoperations.

Our study has shown that this technique variation combining an iliac osteotomy with bulk autograft in cases of developmental hip dysplasia provides early stability and reliable graft incorporation, together with satisfactory clinical and radiological outcomes in the medium term. Longer term study is necessary to confirm the clinical success of this procedure.

Aims. In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods. This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results. In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion. Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437

Primary total hip arthroplasty in patients with osteoarthrosis secondary to developmental hip dysplasia is often more complex due to anterolateral acetabular bone deficiency. Femoral head (shelf) autograft provides a non-immunogenic, osteoconductive lateral support with the potential for enhanced bone stock should revision surgery be required. The technique has been shown in other series to give reliable early results but may be complicated by graft revascularisation and collapse. As yet, no study has assessed shelf grafts long term or quantified the need for further bone graft at revision surgery. This study aims to assess initial graft union rate; quantify long term graft resorption and; quantify the need for further bone graft in the patients requiring revision surgery. A retrospective analysis of a single surgeon's series of 31 THR in 25 patients was conducted. Post-operative, biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range 8-18). Grafts were assessed for union, resorption and displacement. Intra-operative necessity for bone graft at revision surgery was recorded. Union, osseous 93%, fibrous 7%. No grafts displaced. In 71% less than one-third of the graft resorbed, in 29% one-third to one-half resorbed and in no grafts did greater than a half resorb. Of 10 patients revised, 2 required bone graft for inadequate bone stock. Femoral head autograft allows effective acetabular coverage with excellent rates of union, minimal graft resorption in the long term and improves bone stock in revision surgery

Anterolateral acetabular bone deficiency is one of the problems associated with total hip arthroplasty in patients with developmental dysplasia of the hips. We studied the integration of the acetabular reconstruction (cemented socket) in a bulk femoral head autograft. Between 1995 and 2003, we compared 10 patients with a second group who were treated by means of uncemented acetabular components. All the patients had complained of moderate to severe pain. The techniques for the two procedures, cemented and uncemented, were comparable. Out of the 10 cemented procedures, one failed. In the uncemented cup procedure, one also failed after surgery. The results were comparable with published figures and encourage us to continue using the cemented procedure

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

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

The February 2015 Hip & Pelvis Roundup³⁶⁰ looks at: Hip arthroplasty in Down syndrome; Bulk femoral autograft successful in acetabular reconstruction; Arthroplasty follow-up: is the internet the solution?; Total hip arthroplasty following acetabular fracture; Salvage arthroplasty following failed hip internal fixation; Bone banking sensible financially and clinically; Allogenic blood transfusion in arthroplasty.