Periacetabular reconstructions using massive allografts

Abstract

Surgical techniques in acetabular revision for bone loss are related to the size and localization of acetabular defects, as described by Paprosky and revised by Italian Group of Revision prosthesis (GIR). In larger defects there is a definite indication for massive allografts.The use of these allografts should depend from a strict selection of the graft, performed in cooperation with the tissue bank and using accurate radiological studies (CT); grafts should be reinforced with metal cages and cups with large head diameter to avoid dislocations. In our experience we prefer performing a pressurized cementing of the allograft before applying the metal cage. It is mandatory to obtain a good bone-to-bone contact between osteotomies, and the fixation must be reinforced on the posterior column.In addition to a large head diameter, a snap-fit cup may be used. Significant attention should also be paid to muscular reattachment for functional outcome and antibiotic prophylaxis must be performed due to the higher risk of infection in revision surgery. By following these instructions results of massive allografts for periacetabular reconstructions may be superior to custom-made metallic prostheses, as shown by many Authors. In the end, even if not free from major complications, massive allograft reconstruction still remain of primary interest and is the main option in hip revision surgery in cases of large bone defects.