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High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia.

Kim M, Kadowaki T - Clin. Orthop. Relat. Res. (2010)

Bottom Line: Autografting with the removed femoral head has been used for several decades to achieve better coverage, but the long-term benefits of this technique remain controversial, with some series reporting high rates of graft resorption and collapse.We believe the radiodense bands represent a radiographic sign of successful completion of repair of the deficient acetabulum.Congruous and stable contact of the cancellous portion of the graft to the host bed by impaction and use of improved porous cementless sockets may be associated with successful socket survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Suita Municipal Hospital, 13-20, 2 Choume, Katayamachou, Suita City, Osaka, Japan. gskim@iris.eonet.ne.jp

ABSTRACT

Background: Deficient acetabula associated with acetabular dysplasia cause difficulty achieving adequate coverage of the acetabular component during THA. Autografting with the removed femoral head has been used for several decades to achieve better coverage, but the long-term benefits of this technique remain controversial, with some series reporting high rates of graft resorption and collapse.

Questions/purposes: We evaluated the fate of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia.

Patients and methods: We retrospectively reviewed 70 patients (83 hips) (68 women, two men) with a mean age of 57 years at index surgery. According to the classification of Crowe et al. for hip dysplasia, 10 hips were classified as Type I, 45 as Type II, 19 as Type III, and nine as Type IV. Minimum followup was 9 years (mean, 11 years; range, 9-14 years).

Results: We observed no collapsed grafts. In all patients we observed disappearance of the host-graft interface and appearance of radiodense bands in the grafts bridging host iliac bone and at the lateral edges of the acetabular sockets; remodeling with definite trabecular reorientation was seen in 90%. The 10-year survival rate without acetabular revision for any reason was 94%. The mean Merle d'Aubigné and Postel hip score improved from a mean of 9.1 preoperatively to 17.2 at last followup.

Conclusions: Cementless THA combined with autologous femoral bone graft in patients with developmental dysplasia resulted in a high rate of survival. Structural bone grafting achieved a stable construct until osseointegration occurred. We believe the radiodense bands represent a radiographic sign of successful completion of repair of the deficient acetabulum. Congruous and stable contact of the cancellous portion of the graft to the host bed by impaction and use of improved porous cementless sockets may be associated with successful socket survival.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Related in: MedlinePlus

A diagram illustrates the projected percentage horizontal coverage above the socket calculated as (horizontal host bone distance [B]/horizontal distance between the medial and the lateral edge of the socket [A]) × 100%.
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Fig3: A diagram illustrates the projected percentage horizontal coverage above the socket calculated as (horizontal host bone distance [B]/horizontal distance between the medial and the lateral edge of the socket [A]) × 100%.

Mentions: Standard AP radiographs were taken immediately after the operation; 2, 4, 6, 9, and 12 months after the operation; and every 6 or 12 months thereafter. All assessments were made by one of us (MK). The degree of coverage (Fig. 2) or percentage of horizontal coverage by host and graft bone (Fig. 3) was determined on postoperative radiographs [32]. As a measure of coverage, we calculated three center-edge (CE) angles: (1) CE, the angle between the vertical line of the socket center and the original lateral edge of the acetabulum (which was also the medial edge of the graft bone) immediately postoperatively; CE II, the angle between the vertical line of the socket center and the lateral edge of the graft bone immediately postoperatively; and CE III, the angle between the vertical line of the socket center and the lateral edge of the graft bone at the last visit (Fig. 2). The projected percentage horizontal coverage above the socket was determined using the following formula: (horizontal host bone distance/horizontal distance between the medial and the lateral edge of the socket) × 100% (Fig. 3). On final followup radiographs, the horizontal host bone distance represented the distance of the graft and host bone because the interface between the host bone and graft bone was obscure.Fig. 2


High long-term survival of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia.

Kim M, Kadowaki T - Clin. Orthop. Relat. Res. (2010)

A diagram illustrates the projected percentage horizontal coverage above the socket calculated as (horizontal host bone distance [B]/horizontal distance between the medial and the lateral edge of the socket [A]) × 100%.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2865593&req=5

Fig3: A diagram illustrates the projected percentage horizontal coverage above the socket calculated as (horizontal host bone distance [B]/horizontal distance between the medial and the lateral edge of the socket [A]) × 100%.
Mentions: Standard AP radiographs were taken immediately after the operation; 2, 4, 6, 9, and 12 months after the operation; and every 6 or 12 months thereafter. All assessments were made by one of us (MK). The degree of coverage (Fig. 2) or percentage of horizontal coverage by host and graft bone (Fig. 3) was determined on postoperative radiographs [32]. As a measure of coverage, we calculated three center-edge (CE) angles: (1) CE, the angle between the vertical line of the socket center and the original lateral edge of the acetabulum (which was also the medial edge of the graft bone) immediately postoperatively; CE II, the angle between the vertical line of the socket center and the lateral edge of the graft bone immediately postoperatively; and CE III, the angle between the vertical line of the socket center and the lateral edge of the graft bone at the last visit (Fig. 2). The projected percentage horizontal coverage above the socket was determined using the following formula: (horizontal host bone distance/horizontal distance between the medial and the lateral edge of the socket) × 100% (Fig. 3). On final followup radiographs, the horizontal host bone distance represented the distance of the graft and host bone because the interface between the host bone and graft bone was obscure.Fig. 2

Bottom Line: Autografting with the removed femoral head has been used for several decades to achieve better coverage, but the long-term benefits of this technique remain controversial, with some series reporting high rates of graft resorption and collapse.We believe the radiodense bands represent a radiographic sign of successful completion of repair of the deficient acetabulum.Congruous and stable contact of the cancellous portion of the graft to the host bed by impaction and use of improved porous cementless sockets may be associated with successful socket survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Suita Municipal Hospital, 13-20, 2 Choume, Katayamachou, Suita City, Osaka, Japan. gskim@iris.eonet.ne.jp

ABSTRACT

Background: Deficient acetabula associated with acetabular dysplasia cause difficulty achieving adequate coverage of the acetabular component during THA. Autografting with the removed femoral head has been used for several decades to achieve better coverage, but the long-term benefits of this technique remain controversial, with some series reporting high rates of graft resorption and collapse.

Questions/purposes: We evaluated the fate of bulk femoral head autograft for acetabular reconstruction in cementless THA for developmental hip dysplasia.

Patients and methods: We retrospectively reviewed 70 patients (83 hips) (68 women, two men) with a mean age of 57 years at index surgery. According to the classification of Crowe et al. for hip dysplasia, 10 hips were classified as Type I, 45 as Type II, 19 as Type III, and nine as Type IV. Minimum followup was 9 years (mean, 11 years; range, 9-14 years).

Results: We observed no collapsed grafts. In all patients we observed disappearance of the host-graft interface and appearance of radiodense bands in the grafts bridging host iliac bone and at the lateral edges of the acetabular sockets; remodeling with definite trabecular reorientation was seen in 90%. The 10-year survival rate without acetabular revision for any reason was 94%. The mean Merle d'Aubigné and Postel hip score improved from a mean of 9.1 preoperatively to 17.2 at last followup.

Conclusions: Cementless THA combined with autologous femoral bone graft in patients with developmental dysplasia resulted in a high rate of survival. Structural bone grafting achieved a stable construct until osseointegration occurred. We believe the radiodense bands represent a radiographic sign of successful completion of repair of the deficient acetabulum. Congruous and stable contact of the cancellous portion of the graft to the host bed by impaction and use of improved porous cementless sockets may be associated with successful socket survival.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Show MeSH
Related in: MedlinePlus