Abstract
Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.
Highlights
With the ageing of the population and a life expectancy increase in the Western world, there will be a greater demand for total hip replacement procedures and, subsequently, of hip revisions.In the United States, more than 300,000 total hip replacements (THAs) are performed yearly and, according to the National Inpatient Sample of the US, over 250,000 THA revisions were performed between 2009 and 2013 [1]
This is a retrospective case series of patients who underwent an acetabular revision associated with the use of the bone substitute Engipore between January 2014 and December 2016
We recorded a significant improvement in clinical function: the WOMAC score changed from was available in 28 cases
Summary
With the ageing of the population and a life expectancy increase in the Western world, there will be a greater demand for total hip replacement procedures and, subsequently, of hip revisions. In the United States, more than 300,000 total hip replacements (THAs) are performed yearly and, according to the National Inpatient Sample of the US, over 250,000 THA revisions were performed between 2009 and 2013 [1]. The revision surgery rate is expected to grow by 137%. By the end of 2030 [2]. The main indications for revision surgery are hip instability and aseptic loosening of the implant, accounting for 42% of all revision procedures [3]. Res. Public Health 2020, 17, 5624; doi:10.3390/ijerph17155624 www.mdpi.com/journal/ijerph
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