Free Iliac Crest Research Articles

Denosumab combined with en bloc resection and arthrodesis for recurrent grade 3 giant cell tumor of bone in distal radius

PurposeThis study aimed to analyse the clinical outcomes of preoperative adjuvant denosumab therapy (PADT) combined with resection and arthrodesis for recurrent grade 3 giant cell tumor of bone (GCTB) in the distal radius.MethodsA retrospective study was conducted on twenty-three patients (8 males, 15 females) who were treated with the adjuvant denosumab combined with en bloc resection (EBR) and arthrodesis for biopsy confirmed recurrent Campanacci III giant cell tumor of bone in the distal radius between January 2015 and December 2022. All 23 patients were treated with wrist arthrodesis reconstruction using autogenous free iliac crest bone graft (ICBG), bridging plate and screws. The local control, metastasis and overall survival were evaluated during the follow-up period. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score, Musculoskeletal Tumor Society Score (MSTS-87 and MSTS-93), and grip strength in the follow-up period. Additionally, all surgical or denosumab-related complications that occurred were recorded in this study.ResultsTwenty-three patients were included in this retrospective study and no patients were lost in the follow-up period. The average patient age was 32.5 ± 10.2 years (range, 19–53 years) and the mean follow-up time was 35.5 ± 18.4 months (range, 13–72 months). The average tumor length was 71.7 ± 8.7 mm (range, 50 to 85 mm) and bone reconstruction length was 78.5 ± 8.5 mm (range, 60 to 90 mm). Four patients (17.4%) had secondary local recurrence after reoperation and two patients had (8.7%) multiple recurrences. One patient (4.3%) was deceased in the last follow-up due to multiple metastases. The estimated 5-year recurrence-free survival rate was 81.3% and 5-year metastasis-free survival rate was 95.7%. The mean union time was 8.5 ± 1.9 (6–12) months and the overall survivorship of the allograft was 82.7% (21/23) at an average 35 month follow-up. The average MSTS-87 and MSTS-93 scores were 27.8 ± 1.6 (range, from 23 to 30) and 91.5 ± 5.0 (range, from 76 to 100), and the average DASH score was 8.9 ± 3.2 (range, from 3 to 15), respectively. The average grip strength was 64.6 ± 15.7% (range, from 30 to 95%) of the uninvolved side. Eight patients (34.7%) had at least one complication in the follow-up time. Two autografts (8.7%) were removed due to local recurrence and bone nonunion, and the average autograft survival time was 32.8 ± 18.5 months (range, 12 to 72 months).ConclusionsPreoperative adjuvant denosumab therapy (PADT) combined with en bloc resection and arthrodesis is a promising method for the treatment of recurrent Campanacci III GCTB in distal radius with acceptable short-term local control and functional satisfaction.Level of evidence: level IV Therapeutic.

Axial split step osteotomy of free iliac crest flaps for mandible reconstruction: Preliminary results.

Vascularized bone grafting (VBG) is preferred for mandibular reconstruction post-tumor ablation. Although various bone-free flaps are used, their application is compromised by limitations including insufficient bone volume and poor shape. Here, we report mandibular reconstruction using axial split-step osteotomy with an iliac crest-free flap. Over December 2018-November 2020, 12 patients underwent mandibular reconstruction via axial split osteotomy using a free iliac-crest flap. The preoperative iliac-crest length was 5.7-9.5 mm (median, 7.5 cm); the mean post-axial split-osteotomy iliac-crest length increased to 9.59 mm (range, 6.34-15.15 mm). All patients presented with initial healing 2 weeks postoperation; good bone healing was achieved in all grafted flaps by the third month of follow-up. We propose a new axial split-step osteotomy technique using free iliac-crest flaps for mandibular reconstruction. We demonstrated this novel technique's reliability for safe and effective bone lengthening and establishing a reliable occlusal relationship.

Posterior Shoulder Instability and Glenoid Bone Loss: A Review and a Free Bone Graft Technique.

Posterior glenoid bone loss (pGBL) is frequently associated with posterior shoulder instability. Posterior glenohumeral instability accounts for a small percentage of shoulder pathologies, and critical bone loss in posterior instability has not been well defined in the literature. Younger patient populations who participate in activities that repetitively stress the posterior stabilizing structures of the shoulder are more prone to developing posterior shoulder instability. A variety of surgical options have been described, ranging from isolated capsulolabral repair to glenoid osteotomy. Soft-tissue repair alone may be an inadequate treatment in cases of pGBL and places patients at a high risk of recurrence. Our preferred technique for posterior glenoid reconstruction in cases of pGBL involves the transfer of a free iliac crest bone graft onto the native glenoid. The graft is contoured to fit the osseous defect and secured to provide an extension of the glenoid track. In this study, we review pGBL in the setting of posterior instability and describe our technique in detail. Further long-term studies are needed to refine the indications for glenoid bone graft procedures and quantify what constitutes a critical pGBL.

Free iliac crest grafting technology for the management of critical-sized tibial bone defect

ObjectiveTo introduce the method and experience of treating critical-sized tibial bone defect by taking large iliac crest bone graft.MethodsFrom January 2020 to January 2022, iliac crest bone grafting was performed in 20 patients (10 men and 10 women) with critical-sized tibial bone defect. The mean length of bone defect was 13.59 ± 3.41. Bilateral iliac crest grafts were harvested, including the inner and outer plates of the iliac crest and iliac spine. The cortical bone screw was used to integrate two iliac bone blocks into one complex. Locking plate was used to fix the graft-host complex, supplemented with reconstruction plate to increase stability when necessary. Bone healing was evaluated by cortical bone fusion on radiographs at follow-up, iliac pain was assessed by VAS score, and lower limb function was assessed by ODI score. Complications were also taken into consideration.ResultsThe average follow-up time was 27.4 ± 5.6 (Range 24–33 months), the mean VAS score was 8.8 ± 1.9, the mean ODI score was 11.1 ± 1.8, and the number of cortical bone fusion in the bone graft area was 3.5 ± 0.5. Satisfactory fusion was obtained in all cases of iliac bone transplant-host site. No nonunion, shift or fracture was found in all cases. No infection and bone resorption were observed that need secondary surgery. One patient had dorsiflexion weakness of the great toe. Hypoesthesia of the dorsal foot was observed in 2 patients. Ankle stiffness and edema occurred in 3 patients. Complications were significantly improved by physical therapy and rehabilitation training.ConclusionFor the cases of critical-sized tibial bone defect, the treatment methods are various. In this paper, we have obtained satisfactory results by using large iliac bone graft to treat bone defect. This approach can not only restore the integrity of the tibia, but also obtain good stability with internal fixation, and operation skills are more acceptable for surgeons. Therefore, it provides an alternative surgical method for clinicians.

Microsurgical reconstruction of the mandible part II: new classification system and algorithm

BackgroundVarious classifications of mandibular defects have been attempted, but no universally accepted system exists. After 25 years of experience, the senior author idealized a new mandibulectomy classification which could give a more detailed anatomical description leading to a more precise algorithm for reconstruction.MethodsA new classification of mandibular defects is proposed: class I (anterior arch), class II (body), class III (ascending ramus), class IV (hemimandibulectomy), and class V (extended mandibulectomy). Each class is further subdivided into those that preserve or resect intra- and/or extraoral soft tissues (ABCD). This classification takes in account four factors that need to be thought when planning mandibular reconstruction: location/specificity of the defect, osteotomies, and bone and soft tissue requirements.ResultsA total of 218 defects were classified according to this new classification. Nearly 40% of the cases were classified as a class I defect followed by class IV (36,7%), class II (16%), class V (6,8%), and class III (0,5%). The authors also created an algorithm for reconstruction. In cases of an “only-bone” defect, the free iliac crest flap is the preferable choice, especially in class I and IV. When intra- or extraoral soft tissue is needed (types B and C), the fibula flap is our choice of excellence. In cases of extensive defects (type D), the fibula flap and the sequentially linked flow through flap are the preferred options.ConclusionsOptimizing mandibular defect classification with better integration of data-driven information along with clinicopathological evidences and related experience allows for better clinical judgment and choices. We believe that our new classification system and algorithm for reconstruction can be a valuable guiding tool for dealing with complex mandibular reconstruction.Level of evidence:Level III, therapeutic study

Reconstruction of Traumatic Medial Malleolus Loss With a Free Iliac Crest Autograft: Case Report

Background. In the world literature only a few cases of medial ankle reconstruction after its traumatic loss were described. The authors have not found similar cases in the Russian-language literature.
 The aim of the study is to show a rare clinical case of a patient with a traumatic defect of the medial ankle and to describe the method of its reconstruction.
 Case presentation. A 52-year-old patient suffered a motorcycle injury resulting in an open fracture of the medial ankle with bone fragment loss. The patient was taken to a medical facility where he underwent primary surgical treatment with wound suturing. Three months later, the reconstruction of the medial ankle with a free iliac crest autograft, medial ankle osteosynthesis and deltoid ligament plasty were carried out at N.N. Priorov National Medical Research Center of Traumatology and Orthopedics. In the postoperative period, immobilization of the ankle joint was performed for 4 weeks followed by the active development of motions and partial weight bearing 8 weeks after the surgery. The AOFAS score 12 months after the reconstruction was 93 points. According to CT scans, complete autograft integration was achieved and no signs of instability of the ankle joint were observed. The patient was satisfied with the performed surgical treatment.
 Conclusion. The most optimal method of treatment in case of traumatic defect of the medial ankle is its reconstruction with a free iliac crest autograft. This allows us to form a graft of required parameters and shape, minimizing the risk of postoperative complications.

Mandibular distraction of free iliac crest bone graft as treatment in a patient with a history of gunshot wound. Case Report

Introduction: The combination of non-vascularized iliac crest bone graft and distraction osteogenesis in a second surgical intervention has only been described to achieve alveolar ridge augmentation. This technique is not recommended to treat bone defects of the jaws caused by firearm projectile. Case presentation: 40-year-old woman with a segmental mandibular defect in the mandible body caused by the impact of a firearm projectile at the age of 1 year. The patient developed a severe Class II dentofacial anomaly that required a two-stage treatment; she underwent mandibular reconstruction with free iliac crest bone graft followed by a bilateral mandibular distraction at the level of the iliac crest bone graft. With these interventions, a remarkable improvement of the patient's malformation was achieved. Conclusion: Horizontal distraction of the free iliac crest bone graft is a safe and predictable procedure to treat dentolabial anomalies requiring mandibular reconstruction. This procedure was performed in the patient without complications. Further studies on the effectiveness of this technique are required.

Pediatric mandible reconstruction using free iliac crest flap with growth center: flap growth assessment after long-term follow-up

Pediatric mandible reconstruction using free iliac crest flap with growth center: flap growth assessment after long-term follow-up

Maxillary reconstruction with free iliac crest flap in a pediatric patient: long-term results

Maxillary reconstruction with free iliac crest flap in a pediatric patient: long-term results

Full-staged digital and prosthetic guided protocol for the insertion of dental implants in autogenous free bone grafts after reconstruction of segmental mandibular defects.

This study aims to evaluate the clinical and radiographic outcomes of dental implants, inserted in consolidated free bone grafts; postsegmental mandibular resection, after following a fully guided staged protocol, which established a systematic approach that correlates the grafted bone and the enclosed implants to the undisturbed mandibular segments and the maxillary occlusal plane. Seven patients were enrolled in the study; all were diagnosed for mandibular locally aggressive tumors. All of the patients were subjected to computer-guided segmental mandibular resections, secondary free iliac crest bone graft; aided by computer-guided harvest and prosthetic guidance of the graft positioning and fixation. Finally, the guided bone grafts; after being consolidated, received twenty-nine computer-guided dental implants. By the end of the period of osseointegration, the predetermined criteria of implant success judged the success of twenty-five implants, versus the failure of four implants, with (86.2%) percentage of success. The clinical and radiographic assessments demonstrated sound base bone grafts, which succeeded not only to restore the native mandibular continuity and configuration but also to direct the fair-sized embedded dental implants into favorable coastal locations and axial projections, which influenced a smooth prosthetic rehabilitation.

Airbag cover impact: a rarely seen reason for mandibular defects.

Airbags and seatbelts are among the primary means of preventing severe injuries after motor vehicle accidents. Nonetheless, many studies have examined injuries that were related to airbag deployment. To our knowledge, this is the first case report of multiple mandible fractures caused by impact with the airbag cover. Removal of non-viable bone fragments was performed and the resulting hemi-mandible defect was reconstructed with a free iliac crest flap. A radial forearm free flap was used to reconstruct the mucosal defect. Airbags can prevent deadly injuries; however, they can also cause serious harm to the maxillofacial bones at the time of deployment.

A Comparison of Bone Resorption Over Time: An Analysis of the Free Scapular, Iliac Crest, and Fibular Microvascular Flaps in Mandibular Reconstruction

The aim of the present study was to compare the resorption of the bone in the free scapular, free iliac crest, and free fibular microvascular flaps in mandibular reconstruction over time. In the present retrospective study, we analyzed 186 consecutive patients with scapular, fibular, or deep circumflex iliac artery (DCIA) osseous free microvascular flaps in mandibular reconstruction. We followed up the patients clinically and using multislice computed tomography (MSCT) with volume analyses of the bone. The volume of the bone was analyzed against time. A total of 38 patients fulfilled the study criteria. Resorption of the osseous flaps was found to continue for several years. At 2years, the volume loss was 14% for the scapula, 3% for the DCIA, and 1% for the fibula. Three-dimensional (3D) volume analysis of the MSCT scans showed more resorption than 2-dimensional analyses of the radiographs. Postoperative radiation therapy, patient age, and patient gender did not correlate with bone resorption. After microvascular mandibular reconstruction, the volume reduction over time is the least in the fibula and the greatest in scapula, with that of the DCIA in between. The volume reduction continues for several years in all of these. For assessment of the volume reduction of osseal reconstruction, a 3D volume analysis is more reliable than height by width measurements.

Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction.

Background Reconstruction of extensive bone and compound defects in the foot and ankle is challenging. This cross-sectional study aimed to assess the outcomes of free iliac crest flap in foot and ankle reconstruction. Methods We retrospectively reviewed patient records and identified 13 cases with 1 osseous and 12 composite free iliac crest grafts for compound fracture (n = 3) or sequelae (n = 10) in the foot and ankle. We applied the visual analogue scale foot and ankle, the Oswestry disability index, and the 15D health-related quality of life (HRQoL) instruments. Results The average follow-up period was 3.9 years (range, 1.3-8.0 years). Four patients underwent early reoperations; venous and arterial reanastomosis (n = 1), minor wound revision (n = 2), or flap reconstruction due to partial necrosis of the skin island (n = 1). The median time to bone union was 23 months (range, 7-46 months). One permanent pseudoarthrosis occurred. One patient underwent late below-knee amputation due to chronic pain and functional impairment. One patient required flap reconstruction due to a late donor-site defect. Seven patients completed the questionnaires on an average of 14.7 years postoperatively (range, 2.0-26.9 years). Noted impairment of the donor site and of the reconstructed limb ranged from none to significant. Five (out of seven) patients had a HRQoL comparable to that of an age-standardized general population. Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation.

Immediate loaded implant-supported prosthesis after mandibular reconstruction with free iliac crest bone graft

The head and neck are commonly affected in gunshot injuries and this can cause functional and esthetic defects in the maxillofacial region. Mandibular discontinuity is an important esthetic and functional problem and its reconstruction represents a huge challenge. The opening, closing, lateral and protrusive movements of the mouth are diminished and malocclusion can occur. The purpose is to report a clinical case of a 44 years man who had an immediate loaded implant-supported prosthesis after six months of mandibular reconstruction with free iliac bone grafting of a greatmandibular defect caused by gun shot. Autogenous bone grafting is the most predictable treatment from the available reconstruction options for mandibular bone defects. Reconstructed patients can achieve good results with dental implants and implant-supported prostheses with immediate loading. This treatment can promote better masticatory function, improving the nutrition capacity, facial symmetry, muscular equilibrium, better diction and quality of life.

Microsurgical reconstruction of the maxilla: Algorithm and concepts

The main purpose of this article is to highlight free tissue transfers as the first-choice method for three-dimensional (3D) maxillary reconstruction, particularly in providing enough bone for palate and maxillary arch reconstruction and consequently an implant-retained prosthesis. To achieve this, the myosseous free iliac crest was selected whenever possible as the first choice inside the reconstructive algorithm and free flap armamentarium. A new maxillectomy classification and algorithm reconstruction are proposed. Technical modifications and improvements accomplished over time are discussed, considering palate, dental implants and prosthesis, nasal sidewall, cranial base and dura, as well as recipient vessels. We present functional and aesthetic outcomes of the senior author's past 24-year experience (H. C.) with complex midface reconstructions. The authors report and analyse a 24-year experience with 57 midface defects in 54 patients (30 males and 24 females). A total of 57 maxillary defects - classified as Class I (limited maxillectomy)=12, Class II (subtotal maxillectomy)=15, Class III (total maxillectomy)=19 and Class IV (orbitomaxillectomy)=11 - were analysed regarding sex, age, tumour recurrence, free flap, reconstruction and necrosis. In addition, functional outcomes were evaluated regarding diet, speech, globe position and vision, while aesthetic outcomes were evaluated by patient and surgeon scores. A total of 52 free flaps were performed in 47 patients; three patients were operated upon twice; and two other patients needed two sequentially linked flow-through flaps. The free flap survival was 96% with two total flap losses (4%). The other seven patients were fitted with a soft tissue-retained obturator prosthesis. Microsurgical vascularised osteomyocutaneous free flaps are actually the gold standard for reconstruction of complex defects following maxillectomy. This algorithm is based on the anatomofunctional defect of the maxilla and it facilitates flap selection, which is a must.

Virtual Planning and Application of Computer-aided Designed/ Computer-aided Manufactured Technique for Reconstruction of Mandible Defects with Iliac Crest Flaps

Virtual Planning and Application of Computer-aided Designed/ Computer-aided Manufactured Technique for Reconstruction of Mandible Defects with Iliac Crest Flaps Background: Over the past years, the application of computeraided designed/ computer-aided manufactured (CAD/CAM) technique for reconstruction of defects of the facial skeleton has moved into the focus of reconstructive surgery. We report herein our considerations and experiences using CAD/CAM technique in the reconstruction of mandibular defects with free non-vascularized and vascularized iliac crest bone flaps. Case report: Three cases are presented in which subjects received an osseous reconstruction using CAD/CAM technique. In the first case, a free iliac crest transplant was used for reconstruction of a mandibular defect consisting essentially of the alveolar ridge. In the second case, a vascularized iliac bone transplant was performed to reconstruct the mandibular ramus and angle. The third case comprised the reconstruction of a wide mandibular defect using a vascularized three-segment iliac crest flap. Our experiences in the presented cases were especially that the CAD/CAM technique facilitated finding and harvesting bone segments that closely duplicated the shape of the natural mandible. Hence, accuracy was high and further trimming and blurring of the osseous transplant was not necessary. Conclusion: Our experiences fulfilled the challenge to improve traditional shaping methods. At the current state of the art, we believe that the application of CAD/CAM techniques is helpful to restore both complex and less complex mandible defects.

Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning

Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5 N vs 27.3 ± 6.9 N) and anteroinferior translation (22.0 ± 5.3 N vs 29.3 ± 6.9 N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.

Reconstruction of an Extensive Plantar Defect with Two Simultaneous Free Flaps: A Case Report.

Heel reconstruction after tumor ablative surgery or trauma presents the patient and the clinician with difficult treatment choices1-3. The heel region has complex osseous interactions, ligamentous slings, and unique skin coverage that provides sufficient cushion, all of which are crucial for normal gait4. Although there are regional pedicle flap options, reconstruction of these complex tissue defects usually requires free flaps. Regional fasciocutaneous flaps can resurface the defect efficiently. However, when there is a complex tissue defect that includes the calcaneus, more complex treatment options are needed5. In this case report, we describe how we reconstructed the heel region in a patient with an extensive plantar defect, with simultaneous use of free iliac crest and latissimus dorsi muscle flaps. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-nine year-old man presented with a Marjolin ulcer on the right heel. He had an ulcerated and vegetating mass that measured 14 × 7 cm (Fig. 1). An incisional biopsy revealed squamous-cell cancer. Physical examination and preoperative computed tomography (CT) demonstrated calcaneal invasion and excluded lymph node involvement. He had difficulty walking and had moderate pain. The American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score was 626. The tumor was stage III, which necessitated amputation of the foot. However, because the patient would not consent to amputation, the surgical team formulated an alternative plan. Fig. 1 Preoperative photograph of the ulcerated mass, which covered nearly the entire sole region. The calcaneus, the flexor hallucis longus tendon, the posterior tibial tendon, and the flexor digitorum longus tendon were resected along with two-thirds of the sole of the foot. The Achilles tendon was stripped off of the calcaneus. After wide resection of the tumor and …

Comment on Zeng et al.: Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Dear Editor, We read with great interest the article by Zeng et al. [1] on the management of osteonecrosis of the femoral head by a novel approach using the greater trochanter flap and combined free iliac crest flap, and their work should be praised. The management, as proposed by the authors, uses the flap based on the lateral circumflex femoral artery along with impaction grafting. After reading the article though, we have the following queries: The authors describe results of 58 cases with 64 hips treated with the procedure but they have not mentioned the aetiologies of the avascular necrosis in the treated hips. As very rightly pointed out by the authors in their discussion, Korompilias et al. [2] have correlated the results of hip preservation surgery with the pathology of AVN. Baksi et al. [3] also reported good results in idiopathic and steroid-induced AVN as compared to post traumatic osteonecrosis which was associated with delayed recovery and healing. Details about the aetiologies of the treated hips in this study may thus affect outcome. Baksi et al. [3] reported their results of muscle pedicle graft in 187 femoral heads with average 16.5 years follow up and suggested the patients deemed good candidates for hip preservation surgery should have preservation of range of motion at least in one plane, especially flexion. Did the authors use any such inclusion or exclusion criteria? All the patients included in the study belong to ARCO stage III. Such patients mostly have some associated deformities in the hip joint due to the disease process. Baksi et al. [3] managed these deformities with adductor tenotomies and traction. The authors have not mentioned whether they required any soft tissue release along with the bony procedure and post-operative traction as such releases would also greatly improve the post-operative clinical results. The method of fixation of the greater trochanter flap should be described in more detail. The muscle pedicle graft by Baksi et al. and Meyer et al. [4] was fixed in a trough made in the femoral neck but here the authors describe putting the greater trochanter flap in the cartilage defect created in the head. We agree with the authors that the sample size was small and the group needs to be followed up for a longer period to know the final results of this excellent novel procedure for head preservation in osteonecrosis of the head of the femur. We thank the authors for their invaluable work.

The use of a structural free iliac crest autograft for the treatment of acetabular fractures

Bone and cartilage deficits in the posterior acetabular wall are severe complications resulting from the unsuccessful management or delayed treatment of acetabular fracture. This potentially disastrous condition cannot be treated reliably with the use of reconstruction plates and screws alone. Therefore, this technical report describes a modified anatomical reconstruction method that uses a structural iliac crest autograft and an acetabular tridimensional memory alloy fixation system (ATMFS) to treat late-stage deficits in the posterior wall of the acetabulum. This paper also describes a clinical study of 22 patients with an average of 6.3 years follow-up to evaluate the clinical outcomes of this method. Twenty-two patients, who had an acetabular reconstruction between January 2000 and December 2011 that used a structured free iliac crest autograft to treat late-stage bone and cartilage deficits in the posterior acetabular wall were followed annually with clinical and radiographic evaluations. The average age of the patients was 36.4 years at the time of the procedure, and the average time of follow-up was 6.3 years. None of the patients in this study lost reduction after surgery, and there were no cases of implant failure. Radiographic analysis using Matta's X-ray evaluation criteria were excellent in eleven cases, good in eight, and fair on three. The Merle D'Aubigné and Postel clinical outcomes at the final follow-up were as follows: seven cases were excellent, ten cases were good, three cases were fair and two cases were poor. The use of a modified iliac crest grafting and ATMFS fixation, as a biological method to reconstruct the acetabulum anatomically may offer better congruence of the joint surface and may ensure good hip joint stability during early postoperative exercise. The medium to long-term results of this method are encouraging.