Aims: To study clinical and radiological outcome of acetabular revision in THR with porous, hydroxyapatite-coated cups.

Methods: 50 acetabular revisions (48 patients) operated by single surgeon were reviewed. Uncemented, hydroxyapatite coated cup (Mallory/Head, Biomet) was used. Preoperative acetabular bone loss graded by Paprosky’s classification (grade 1: 12, grade 2a: 26, grade 2b: 8, 2c: 2, grade 3a: 2). Acetabulum alone was revised in 22 hips. Duration of follow up: 35 months (24–52). Clinical outcome assessment was done using Merle d’Aubigne and Postel score & QALY index questionnaire. Radiological assessment by standard X-rays taken at the latest review date. No case was lost to follow up.

Results: Merle d’Aubigne & Postel scores improved from 2.1, 2.7 and 2.4 (pre-operative) to 5.0, 4.3 and 4.5 (post-operative) respectively with significant improvement in QALYs scores. Radiological assessment showed no mechanical failures. Good trabecular formation between HA-coating and the bone seen in the majority. Non-progressive radiolucency < 1mm in 6 cases, superior migration > 2 mm in 3 cups where bone graft was used, and < 2mm migration in 9 cups was noted. 2 cases had rerevision for recurrent dislocation.

Conclusions: Hydroxyapatite coating on the implant may enhance bony ongrowth at bone-implant interface giving additional stability. Good midterm results obtained in our study using hydroxyapatite-coated components favour the use of this type of cup in acetabular revisions for moderate bone loss, but a long-term follow up is essential.

This was an assessment of the clinical and radiological outcome of impaction allografting using morselised cancellous bone allograft in femoral component revision in total hip arthroplasty.

27 consecutive femoral revisions operated on by a single surgeon (SJK) since 1995 were reviewed. Morselised bone allograft was used to reconstitute bone stock deficiency. All patients had cemented Exeter X-change technique Patient selection was primarily based on the amount of preoperative bone loss that was graded according to the Endo-Klinik classification. 10 hips were Endo-Klinik grade 2, 16 hips grade 3 and 1 hip grade 4. Both the components were revised in 18 hips.

The duration of follow up was 12–56 months (average: 33 months) Clinical outcome was assessed using the Charnley modification of Merle d’Aubigné and Postel score. Radiographs were standardised & assessment was done on digitised images of the radiographs using the Image Tool program (Wilcox, Dove, McDavid and Greer, UTHSCSA, Texas, USA).

Charnley’s scores improved from a preoperative score of 2.3, 2.6 and 2.6 to 5.3, 4.2 and 4.8 respectively. Radiologically there were 2 cases of subsidence of > 10mm after 24 months postoperatively. Non progressive radiolucent lines of < 2mm were noted in 7 hips at the cement-graft interface while 3 hips had radiolucent lines at the stem-cement interface. There was satisfactory radiological evidence of bone consolidation in 26 of the cases (95%). There have been 2 re-revisions-1 for dislocation and the other for massive subsidence.

Midterm results showed good functional improvement in hips with preoperative grade 2 and 3 bone loss. We believe this technique is effective in treating major bone loss but may be highly operator dependent.