A total of 31 patients, (20 women, 11 men; mean age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone resection-arthroplasty (RA) to a total hip replacement (THR) were compared with 93 patients, (60 women, 33 men; mean age 63.4 years old; 20 to 89), who had revision THR surgery for aseptic loosening in a retrospective matched case-control study. Age, gender and the extent of the pre-operative bone defect were similar in all patients. Mean follow-up was 9.3 years (5 to 18).

Pre-operative function and range of movement were better in the control group (p = 0.01 and 0.003, respectively) and pre-operative leg length discrepancy (LLD) was greater in the RA group (p < 0.001). The post-operative clinical outcome was similar in both groups except for mean post-operative LLD, which was greater in the study group (p = 0.003). There was a significant interaction effect for LLD in the study group (p < 0.001). A two-way analysis of variance showed that clinical outcome depended on patient age (patients older than 70 years old had worse pre-operative pain, p = 0.017) or bone defect (patients with a large acetabular bone defect had higher LLD, p = 0.006, worse post-operative function p = 0.009 and range of movement, p = 0.005), irrespective of the group.

Despite major acetabular and femoral bone defects requiring complex surgical reconstruction techniques, THR after RA shows a clinical outcome similar to those obtained in aseptic revision surgery for hips with similar sized bone defects.

Cite this article: Bone Joint J 2014;96-B:1478–84.

Introduction and Purposes. Custom made acetabular prosthesis are a valid option for the reconstruction after the resection of pelvic tumors. They should guarantee a stable and reliable reconstruction for the expected survival of the patient. Nevertheless in many cases periacetabular metastatic lesions have been compared to high grade (IIIA-B) Paprosky defects, but treated with low or intermediate longevity implants. Some complex post-traumatic scenarios or total hip arthroplasty (THA) multiple failures need a reconstruction according to oncologic criteria to fill in the huge defect and to obtain an acceptable function. The aim of the study is to compare 3D custom-made implants for tumors and for THA failures. Materials and Methods. Three custom-made implants after tumor resection (group A: 1 chondroblastic osteosarcoma, 1 bifasic synovialsarcoma, 1 high grade chondrosarcoma) were evaluated and compared to 3 acetabular complex reconstructions after non-oncologic bone defect (group B: 3 cases of aseptic loosening after at least 2 revisions). All the implants were case-based designed, 3D printed, and realized with porous or trabecular surfaces on a Titanium base prosthesis. Age range 16–70 ys in oncologic patients and 60–75 ys in non-oncologic patients. The bone defect to be reconstructed after tumor resection was classified according to Enneking zones (1 type 1-2-3 resection, 1 type 2 resection, 1 partial type 2 resection). Non-oncologic cases were comparable in term of remaining bone stock and classified according to Paprosky classification for acetabular defects as 1 type IIIA an 2 type IIIB. Complications, MSTS functional score, necessity of walking-aids were evaluated at minimum follow up of 1 year. Results. In both groups, good functional results were obtained (MSTS score 25/30 in both groups). No cases of aseptic loosening and no infection occured. After 3 months of partial or no weight-bearing on the operated limb, 3 patients were able to walk unaided and 3 walked with one cane or crutch. No limb length discrepancy (major than 2 cm) were observed. Limping was present in oncologic cases due to muscle resection. Overall better results in term of satisfaction and quality of life were obtained in younger (oncologic) patients. Conclusions. Complex THA revision cases can sometimes be considered for a reconstruction with oncologic criteria. Even if indications are limited an acceptable functional results can be obtained. In the past for these cases a Girldestone resection was the only option. A collaboration among orthopaedic oncologist and hip arthroplasty surgeons is advisable in major orthopaedic centers to improve the prosthetic design and the functional results

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