Trevor Lawrence
Sep 24, 20206 min
Updated: Jun 6, 2021
Authors
Kanai Garala, Tarek Boutefnouchet, Rishanthanan Amblawaner, Trevor Lawrence
Research:
ACETABULAR RECONSTRUCTION USING A COMPOSITE LAYER OF IMPACTED CANCELLOUS ALLOGRAFT BONE AND CEMENT
First published in Sage Journals July 17, 2020
ABSTRACT
Background:
Revision total hip arthroplasty (rTHA) is often complex and has a less reliable outcome than primary total hip arthroplasty. Acetabular reconstruction remains a challenge because of the variable amount of bone loss. This study describes and evaluates a novel technique of acetabular reconstruction using composite bone grafting.
Surgery performed by Mr Trevor Lawrence
Orthopaedic Consultant at University Hospital Birmingham
Patients and methods:
Between June 2005 and January 2012, 108 consecutive patients underwent revision hip arthroplasty in which the acetabular component was revised using composite bone grafting. Of these, 24 were lost to follow-up leaving 84 in the study with a minimum 5-year follow-up. There were 54 women and 30 men with a mean age of 70.1 (31–91) years. All patients were assessed clinically and radiologically after a minimum of 5 years. The primary outcome measures were rate of re-revision, patient-reported outcomes and radiological evidence of loosening.
Results:
The mean follow-up after revision surgery was 6.9 years (5–10). At operation, 60 patients had an acetabular defect of AAOS stage 3 or more. There was no evidence of loosening in 69 revision acetabular components; 12 showed evidence of non-progressive loosening and 3 patients underwent a re-revision procedure (2 for infection, 1 recurrent dislocation).
The mean postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) was 89.11/100 (95% CI, 87.8–90.5). Scores were significantly improved in patients with a more extensive preoperative defect (p = 0.006). The overall patient satisfaction rate at final follow-up was very high.
Conclusions:
Composite impaction grafting using a layered cement and bone graft technique can give satisfactory clinical and radiological outcomes in the medium- to long-term.
Keywords:
Acetabular reconstruction, cemented acetabular fixation, clinical, impaction grafting, implant survival, radiological outcomes, total hip arthroplasty
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REFERENCES
1. Havelin, LI, Fenstad, AM, Salomonsson, R, et al. The Nordic arthroplasty register association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 2009; 80: 393–401.
Google Scholar | Crossref | Medline | ISI
2. Garcia-Cimbrelo, E, Diez-Vazquez, V, Madero, R, et al. Progression of radiolucent lines adjacent to the acetabular component and factors influencing migration after Charnley low-friction total hip arthroplasty. J Bone Joint Surg Am 1997; 79: 1373–1380.
Google Scholar | Crossref | Medline | ISI
3. Garcia-Cimbrelo, E, Munuera, L, Diez-Vazquez, V. Long-term results of aseptic cemented Charnley revisions. J Arthroplasty 1995; 10: 121–131.
Google Scholar | Crossref | Medline | ISI
4. Benjamin, JB, Gie, GA, Lee, AJ, et al. Cementing technique and the effects of bleeding. J Bone Joint Surg Br 1987; 69: 620–624.
Google Scholar | Crossref | Medline
5. Parratte, S, Argenson, JN, Flecher, X, et al. [Acetabular revision for aseptic loosening in total hip arthroplasty using cementless cup and impacted morselized allograft]. Rev Chir Orthop Reparatrice Appar Mot 2007; 93: 255–263.
Google Scholar | Crossref | Medline
6. Dearborn, JT, Harris, WH. High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg Am 1999; 81: 469–480.
Google Scholar | Crossref | Medline | ISI
7. Callaghan, JJ, Liu, SS, Phruetthiphat, OA. The revision acetabulum–allograft and bone substitutes: vestigial organs for bone deficiency. Bone Joint J 2014; 96–B(Suppl. A): 70–72.
Google Scholar | Crossref | Medline
8. Petrie, J, Sassoon, A, Haidukewych, GJ. Pelvic discontinuity: current solutions. Bone Joint J 2013; 95–B(Suppl. A): 109–113.
Google Scholar | Crossref | Medline
9. Slooff, TJ, Huiskes, R, van Horn, J, et al. Bone grafting in total hip replacement for acetabular protrusion. Acta Orthop Scand 1984; 55: 593–596.
Google Scholar | Crossref | Medline
10. Ibrahim, MS, Raja, S, Haddad, FS. Acetabular impaction bone grafting in total hip replacement. Bone Joint J 2013; 95–B(Suppl. A): 98–102.
Google Scholar | Crossref | Medline
11. Toms, AD, Barker, RL, Jones, RS, et al. Impaction bone-grafting in revision joint replacement surgery. J Bone Joint Surg Am 2004; 86: 2050–2060.
Google Scholar | Crossref | Medline | ISI
12. Haddad, FS, Rayan, F. The role of impaction grafting: the when and how. Orthopedics 2009; 32: 675–679.
13. Sheth, NP, Nelson, CL, Springer, BD, et al. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 2013; 21: 128–139.
Google Scholar | Crossref | Medline | ISI
14. Geerdink, CH, Schaafsma, J, Meyers, WG, et al. Cementless hemispheric hydroxyapatite-coated sockets for acetabular revision. J Arthroplasty 2007; 22: 369–376.
Google Scholar | Crossref | Medline | ISI
15. Palm, L, Jacobsson, SA, Kvist, J, et al. Acetabular revision with extensive allograft impaction and uncemented hydroxyapatite-coated implants. Results after 9 (7-11) years follow-up. J Arthroplasty 2007; 22: 1083–1091.
Google Scholar | Crossref | Medline | ISI
16. Lian, Y, Cho, Y, Zhao, C, et al. [Acetabular revision by using uncemented cup and impacted morselized allografts]. Zhongguo xiu fu chong jian wai ke za zhi 2009; 23: 1062–1066.
17. Busch, VJJF, Gardeniers, JWM, Verdonschot, N, et al. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg Am 2011; 93: 367–371.
Google Scholar | Crossref | Medline | ISI
18. Cross, M, Bostrom, M. Cement mantle retention: filling the hole. Orthopedics 2009; 32: 669–670.
19. D’Antonio, JA, Capello, WN, Borden, LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 1989; 243: 126–137.
20. D’Antonio, JA. Periprosthetic bone loss of the acetabulum. Classification and management. Orthop Clin North Am 1992; 23: 279–290.
Google Scholar | Medline | ISI
21.Nilsdotter, AK, Lohmander, LS, Klässbo, M, et al. Hip disability and osteoarthritis outcome score (HOOS)–validity and responsiveness in total hip replacement. BMC Musculoskelet Disord 2003; 4: 10.
Google Scholar | Crossref | Medline | ISI
22. Borland, WS, Bhattacharya, R, Holland, JP, et al. Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss: Early to medium-term results. Acta Orthop 2012; 83: 347–352.
Google Scholar | Crossref | Medline | ISI
23. Mankin, HJ, Hornicek, FJ, Raskin, KA. Infection in massive bone allografts. Clin Orthop Relat Res 2005; 432: 210–216.
24. Lichte, P, Pape, HC, Pufe, T, et al. Scaffolds for bone healing: concepts, materials and evidence. Injury 2011; 42: 569–573.
Google Scholar | Crossref | Medline | ISI
25. Burchardt, H. The biology of bone graft repair. Clin Orthop Relat Res 1983; 174: 28–42.
26. Emerson, JR, Head, WC, Berklacich, FM, et al. Noncemented acetabular revision arthroplasty using allograft bone. Clin Orthop Relat Res 1989; 249: 30–43.
27. Ito, H, Tanino, H, Yamanaka, Y, et al. Porous-coated cementless acetabular components without bulk bone graft in revision surgery. J Arthroplasty 2010; 25: 1307–1310.
Google Scholar | Crossref | Medline
28. Issack, PS, Nousiainen, M, Beksac, B, et al. Acetabular component revision in total hip arthroplasty. Part I: cementless shells. Am J Orthop (Belle Mead, NJ) 2009; 38: 509–514.
29. Wind, MA, Swank, ML, Sorger, JI. Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 2013; 36: e260–e265.
Google Scholar | Crossref | Medline | ISI
30. Davies, JH, Laflamme, GY, Delisle, J, et al. Trabecular metal used for major bone loss in acetabular hip revision. J Arthroplasty 2011; 26: 1245–1250.
Google Scholar | Crossref | Medline | ISI
31.Alfaro, JJB, Fernández, JS. Trabecular metal buttress augment and the trabecular metal cup-cage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity. Hip Int 2010; 20(Suppl. 7): S119–S127.
Google Scholar | SAGE Journals
32. Mäkinen, TJ, Kuzyk, P, Safir, OA, et al. Role of cages in revision arthroplasty of the acetabulum. J Bone Joint Surg Am 2016; 98: 233–242.
Google Scholar | Crossref | Medline
33. Gauthier, L, Allen, D, Kim, P. Late transection of the sciatic nerve in association with an acetabular reconstruction cage. J Arthroplasty 2010; 25: 333.e21–e24.
Google Scholar | Crossref | Medline
34. Hipfl, C, Janz, V, Löchel, J, et al. Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity: mid-term results of a consecutive series of 35 cases. Bone Joint J 2018; 100: 1442–1448.
Google Scholar | Crossref | Medline
35. Man, WY, Monni, T, Jenkins, R, et al. Post-operative infection with fresh frozen allograft: reported outcomes of a hospital-based bone bank over 14 years. Cell Tissue Bank 2016; 17: 269–275.