Reconstruction of acetabular defect with wire mesh and impacted bone graft in cemented acetabular revision

Abstract

To discuss the method of reconstruction of acetabular bone defect with wire mesh, impaction bone-grafting and a cemented cup in acetabular component revision. 21 hips in 21 patients, aged 50.1 (31 - 64), 2 hips being of the acetabular defect type I B, 1 hip of type II A, 4 hips of type II B, and 14 hips of type III according to the American Academy of Orthopaedic Surgeons (AAOS) grading system underwent reconstruction with wire mesh, impacted bone grafts and cemented polyethylene acetabular component, and then were followed up for 47 months (36 - 60 months). The mean Harris hip score improved from the preoperative 55.7 points to 92.9 points at the last time of follow-up. Radiographic incorporation between host the bone and allograft was achieved 11.4 months after the operation on average. The mean change of inclination of acetabular components was 2.2 degrees , in which one acetabular component developed a change of 15.5 degrees . The inclination of acetabular components increased by 1.7 degrees on average 3 months after the operation and 2.0 degrees 6 months after the surgery. The acetabular cup migrated medially and superiorly by 3.93 mm and 4.41 mm respectively, peaking in the sixth month after the operation. One hip developed heterotopic ossification (Brooker grade I). One hip received repeat revision because of the aseptic loosening of the acetabular component 25 months after the revision surgery. The changes of the position of acetabular cup mainly occur within six months after the reconstruction of severe acetabular bone defect with wire mesh, impacted bone graft and cemented polyethylene acetabular component. To prevent the displacement of the acetabular cup, it is necessary to keep initial stability of the acetabular cups within six months after the index surgery.