Bone grafting in total hip arthroplasty for insufficient acetabulum.

Abstract

We assessed the effectiveness of total hip arthroplasty (THA) supplemented with autologous bone grafts in patients with congenital disease of the hip (CDH). 2 groups of patients were evaluated: In Group A, 33 patients with a mean age of 54 years underwent arthroplasties using a threaded ceramic conical acetabular cup without cement (Autophor). In Group B, 85 patients with a mean age of 55 years underwent arthroplasties using a threaded, noncemented, titanium cup (CST). Bone grafts were supplemented the THA in 3 ways: 1) intrapelvic application using the cotyloplasty technique, 2) as bone chips in order to cover small defects around the upper and lateral part of the cup, and 3) as a bulky corticocancellous graft which was secured with screws. Follow-up averaged 11 and 9 years for patients in Groups A and B, respectively. All the grafts in Group A had consolidated by the end of 6th month. Only 2 partial absorptions were observed, 1 intrapelvic graft and 1 corticocancellous graft. 2 revisions were performed in this group of patients, but neither were related to bone graft absorption. By the end of 6 month, 63 of 85 in Group B had consolidated bone grafts. In 16 patients with intrapelvic cotyloplasty, 3 demonstrated complete and 1 partial absorption of the grafts. 3 cup revisions were performed in this group of patients, all with complete graft absorption. Our findings indicate that autologous bone grafts are strong adjunct for satisfactory fixation of THA in patients with CDH, a particularly demanding group of patients to manage. In addition, the ceramic threaded cup was found to be superior to the titanium threaded cup in terms of both bone graft consolidation and the number of revisions required.