Hip revision surgery in cases with acetabular bone loss: PPR rings, homologous bone and platelet gel

Abstract

Hip revision has several objectives: filling the bone defect, restoring the rotational center of the hip, and restoring limb length and hip function. Recently, through tissue engineering, it became possible to consider a fourth objective: to give a graft improved capability to osteointegrate and to restore bone stock as for amount of bone and bone quality (tissue engineering or bioenhancement). Concerning biomechanical and clinical objectives, rings are the most commonly used prosthesis. We used the Partial Pelvic Replacement (PPR) ring and retrospectively analyzed our patients at a mean follow-up of 27.2 months. We found no signs of radiological failure, no radiolucency or osteolysis, nor implant component ruptures. The mean Harris hip score improved significantly from 35.9 preoperatively to 78.1. As for the anatomical objective of hip revision surgery, homologous bone grafts are the most used means to fill a bone defect. We developed a new method to produce platelet gel as a simple and inexpensive way to obtain autologous growth factors, without any discomfort for the patient. We used platelet gel with PPR rings and homologous bone graft; we report our method and describe the first cases treated, with good results.