Acetabular re-revision with impaction bone grafting and a cemented polyethylene cup; a biological option for successive reconstructions.

Abstract

For the revision of failed acetabular components impaction bone grafting (IBG) with a cemented cup is a well known technique. Claims have been made that this is a biological reconstruction technique, restoring the bone stock loss and thereby facilitating future revisions. However, there are no scientific data proving this claim. In this study, we present the clinical and radiographic outcome of 11 consecutive acetabular re-revisions in 10 patients with again IBG and a cemented polyethylene cup observed in a previously reported cohort of 62 acetabular IBG revisions. All data were prospectively collected. Kaplan-Meier survivorship analysis was performed. The mean follow-up after re-revision was 10 years (5-15) and 28 years (26-30) after the primary revision. No patients were lost to follow-up. The mean HHS improved from 37 (12-49) points to 71 (40-95) points at final follow-up. Survival with further cup revision for any reason as endpoint was 91% (95% confidence interval (CI) 51 to 99) at 10 years. When excluding one early cup re-revision for malpositioning 3 weeks postoperative, survivorship with further cup revision for aseptic loosening as endpoint was 100% (95% CI 37-100) at 10 years. Survival with further cup re-operation for any reason as endpoint was 82% (95% one-sided CI 45-95). In all surviving re-revisions trabecular incorporation was observed without radiolucent lines. This study shows that, due to restoring the bone stock, even successive acetabular reconstructions using IBG and a cemented cup are possible with satisfying 10 years survivorship.