Abstract
BackgroundSevere acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction.MethodsWe retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation.ResultsAll patients were followed up with a mean follow-up of 79.5 months (range 38–141), HHS improved from 31.4 (13–43) points preoperatively to 84.6 (55–94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface.ConclusionThe reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.
Highlights
In revision hip arthroplasty, severe acetabular bone defect is a complex problem with the goals of achieving stable and durable fixation of the acetabular component, restoring acetabular bone stock and reconstructing the hip rotation center [1]
The purpose of this study is to report the mid-long term clinical and radiographic results of using reconstructional cage and morselized allogeneic cancellous bone graft without impaction for Paprosky type III acetabular bone defects in acetabular revision and introduce our experience in bone allografts sterilization
One patient (4%) with pelvic discontinuity suffered re-revision for the cage loosening with one screw breakage at 61 months after surgery, but we found that the allograft bone was partially incorporated with the host bone and the pelvic discontinuity was healing, and we performed the re-revision with jumbo cup and tantalum augment
Summary
Severe acetabular bone defect is a complex problem with the goals of achieving stable and durable fixation of the acetabular component, restoring acetabular bone stock and reconstructing the hip rotation center [1]. There are several reconstruction options to choose, including impaction bone grafting and cemented cup [2], hemispheric acetabular component [3, 4], porous. When the acetabular bone defect is severe, placing the acetabular components to anatomical position and simultaneously achieving stable fixation may be difficult. In this situation, reconstructional cage is an alternative option [16]. Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction
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