Biphasic phospho-calcium ceramics used as bone substitutes are efficient in the management of severe acetabular bone loss in revision total hip arthroplasties.

Abstract

Management of bone loss in revision total hip replacement is a challenge. To eliminate any immunological or infectious problem and so to try to improve the long term results obtained with allografts the authors used synthetic ceramics as bone substitutes. Thirty-two hips with a mean follow-up of about 5.5 years (from 3 years to 8 years) were reviewed for this study. The bone defect was classified according to American Academy for Orthopaedic Surgery classification. Two ceramics, one in granules for cavities filling, another in different forms to reconstruct segmental deficiencies, were used; according to the local bone conditions and the age of the patient no cemented jumbo cups or screwed reconstruction rings with a hook and with a polyethylene cup were implanted. Clinical results were assessed according to Postel and Merle d’Aubigne scale. No specific complications were noted. Other complications as dislocations or infections were on a level with other series in this surgery. Radiological assessment affirmed a good integration without any border in all the cases except in one infection. No secondary displacement occurred except in one case after a fall with an acetabular fracture. A progressive invasion of the ceramics by bone can be seen on the X-ray in all cases. Although 5.5 years of average retreat remain a short follow-up in orthopaedic surgery, the outcomes without specific complications are satisfactory and allow one to go with this materials in total hip revision surgery.