Bulk Allograft Using the Proximal Part of the Femur for a Posterosuperior Acetabular Defect: A Case Report.

Abstract

Acetabular reconstruction in revision total hip arthroplasty can be quite challenging, especially in the presence of substantial acetabular osseous defects. Reconstruction of the acetabulum with severe acetabular bone loss using hemispherical cups with screw augmentation1, antiprotrusio cages2, metal augments3, bulk allografts4, and combinations of these methods2-6 has been described. We report the use of an ipsilateral proximal portion of a femur as a novel allograft source in addition to hemispherical, cementless acetabular reconstruction with screws in the treatment of a Paprosky type-IIIA acetabular defect. The patient was informed that data concerning this case would be presented for publication, and she provided consent. A fifty-seven-year-old woman had a history of a right primary total hip replacement with an uncemented component in 1988 to treat osteoarthritis. This was followed by acetabular revision for isolated aseptic loosening in 2003. The patient presented to the senior author in 2004, eleven months postrevision, with symptoms of increasing inability to bear weight and progressive right hip and buttock pain. Radiographs demonstrated a stable uncemented femoral component as well as gross acetabular loosening and medioinferiorly placed screws (Fig. 1). The patient had a large radiolucency in the area of zone three and superolateral migration of the acetabular component. Preoperative radiographs, including an anteroposterior pelvic view, anteroposterior and lateral views of the hip, and Judet views, demonstrated substantial osseous loss to the posterior wall, posterior column, and acetabular dome. Figure 2 is a representation of the acetabular bone loss seen at the time of revision. The preoperative evaluation included normal serology (C-reactive protein level <3 mg/dL and an erythrocyte sedimentation rate of 10 mm/h), and hip aspiration yielded a negative culture. Fig. 1 Anteroposterior pelvic radiograph demonstrates a grossly unstable right acetabular component with superolateral migration of the cup …