Elsevier

The Journal of Arthroplasty

Volume 15, Issue 8, December 2000, Pages 951-958
The Journal of Arthroplasty

Original Articles
Revision total hip arthroplasty with the use of structural acetabular allograft and reconstruction ring: A case series with a 10-year average follow-up*,**,*

https://doi.org/10.1054/arth.2000.9055Get rights and content

Abstract

From 1980 through 1993, 20 consecutive massive structural acetabular allografts and reconstruction rings were performed in 19 patients. In all cases, the magnitude of the acetabular bone deficiency was such that the allograft supported >50% of the cup. The allograft was necessary to restore normal anatomy, bone stock, and leg length. Of the 19 patients who met the inclusion criteria, 7 subjects died of unrelated causes, and 3 subjects failed and underwent resection arthroplasty, 1 (8%) for graft resorption and 2 (15%) for recurrent dislocation. The remaining 9 patients (10 allografts) had a minimum follow-up of 5 years and average follow-up of 10.5 years. The cohort was analyzed using radiographic and outcome data collection questionnaires (AAOS/HKOD, WOMAC, SF-36). The study supports the use of massive structural allografts and reconstruction rings and achieves satisfactory results in 77% (10 of 13) of the patients. We believe these results reveal an impressive outcome for what used to be thought of as a salvage operation.

Section snippets

Materials and methods

Between January 1, 1980, and May 1993, 20 consecutive massive structural acetabular allografts and reconstruction rings performed were retrospectively reviewed. In all cases, the magnitude of the acetabular bone deficiency was such that the allograft supported >50% of the cup to restore normal anatomy, bone stock, and leg length. All procedures were performed by 1 surgeon and had a minimum follow-up of 5 years.

Of the 20 patients, 7 died of unrelated causes. Three patients (3 allografts)

Results

Twelve patients (13 allografts) were available for analysis, of which 3 patients (3 allografts) underwent resection arthroplasty, leaving 9 patients (10 allografts) for our study (Figs. 3 and 4).

. Type IV defect reconstructed with support ring and structural acetabular allograft. (A) Judet view of left hip showing type IV defect with loose cemented cup and mesh in a 40-year-old women. (B) Sixteen years after reconstruction with acetabular allograft and a Burch-Schneider ring. The ring has been

Discussion

The increasing severity of acetabular bone loss translates into more complex acetabular reconstruction. One technique that can aid the orthopaedist in reconstructing the acetabulum and reconstituting bone stock is to use structural allografts. The use of structural allografts in the literature is controversial. Other studies have reported on and supported the use of structural allografts for massive acetabular defects 18, 28.

Paprosky et al [18] reported on 67 distal femoral allografts performed

Conclusion

The advantages of using a structural allograft include reconstitution of bone stock, restoration of the bone anatomy, and restoration of leg length. This study supports the use of massive structural allograft at an average of 10.5 years, achieving the aforementioned goals with satisfactory results in 77% if the graft is protected by a reconstruction ring. This study incurred a 7.7% (1 of 13) graft resorption rate and a 15.4% (2 of 13) recurrent dislocation rate treated with resection

References (35)

  • AE Gross et al.

    Revision arthroplasty of the acetabulum in association with loss of bone stock

    Instr Course Lect.

    (1999)
  • JA D'Antonio et al.

    Classification and management of acetabular abnormalities in total hip arthroplasty

    Clin Orthop

    (1989)
  • HP Chandler et al.

    Bone Stock Deficiency in Total Hip Replacement: Classification and Management

  • CA Engh et al.

    Cementless revision of failed total hip replacement

    Orthop Rev

    (1990)
  • TJ Gill et al.

    The Burch-Schneider anti-protusio cage in revision total hip arthroplasty: indications, principles and long-term results

    J Bone Joint Surg Br

    (1998)
  • DH Gustafson et al.

    A decision theoretic methodology for severity index development

    Med Decis Making

    (1986)
  • DE Padgett et al.

    Revision of the acetabular component without cement after total hip arthroplasty: three to six-year follow-up

    J Bone Joint Surg Am

    (1993)
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      The results of such reconstruction have been excellent according to multiple studies [23,25,26,28]; however, may have some potential disadvantages including the lack of bone-stock restoration, the difficulty of implanting an augment in an irregularly shaped bone defect and their high costs makes their use prohibitive in certain countries. Other treatment options include the use of a bilobed cups [18,19], cup-cage reconstructions [15,17,38], or custom triflange acetabular components [20,21]. Disadvantages of custom implants include considerable preoperative planning, the delays caused by custom implant fabrication and their costs.

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    *

    †University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.

    **

    No benefits or funds were received in support of this study.

    *

    Reprint requests: Khaled J. Saleh, MD, MSc, FRSC, Department of Orthopaedic Surgery and School of Public Health, University of Minnesota, 420 Delaware Street, Box 492, Minneapolis, MN 55455.

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