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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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The radiographs illustrate the case of a 33-year-old woman with Crowe Type II hip dysplasia. (A) A radiograph taken 3 months postoperatively shows bridging trabeculation. (B) A radiograph taken 3 years postoperatively shows trabecular reorientation. The arrow points to new radiodense lateral bands.
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Fig7: The radiographs illustrate the case of a 33-year-old woman with Crowe Type II hip dysplasia. (A) A radiograph taken 3 months postoperatively shows bridging trabeculation. (B) A radiograph taken 3 years postoperatively shows trabecular reorientation. The arrow points to new radiodense lateral bands.

Mentions: Bridging trabeculae across the graft-host interface were seen in all cases by a mean of 3 months postoperatively (range, 2–6 months). Disappearance of the acetabular bone graft interface line on the AP view was noted at a mean of 8 months postoperatively (range, 3–18 months). Definite trabecular reorientation was seen in 69 of the 77 hips (90%) at a mean of 24 months (range, 9–36 months). Trabecular reorientation in grafted bone was apt to be delayed in hips classified as Type IV (Crowe et al.), probably owing to grafting of larger bone bulk in this type (Table 5). The size of the grafted bone mass reduced slightly during followup. Bone mass reduction was recognized within 8 months and the incorporated bone mass was maintained thereafter. On the last radiographs, new radiodense lateral bands were frequent (in 71 hips) (Fig. 7). These bands were present in the region of the original subchondral portion of the femoral head graft.Table 5


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)

The radiographs illustrate the case of a 33-year-old woman with Crowe Type II hip dysplasia. (A) A radiograph taken 3 months postoperatively shows bridging trabeculation. (B) A radiograph taken 3 years postoperatively shows trabecular reorientation. The arrow points to new radiodense lateral bands.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2865593&req=5

Fig7: The radiographs illustrate the case of a 33-year-old woman with Crowe Type II hip dysplasia. (A) A radiograph taken 3 months postoperatively shows bridging trabeculation. (B) A radiograph taken 3 years postoperatively shows trabecular reorientation. The arrow points to new radiodense lateral bands.
Mentions: Bridging trabeculae across the graft-host interface were seen in all cases by a mean of 3 months postoperatively (range, 2–6 months). Disappearance of the acetabular bone graft interface line on the AP view was noted at a mean of 8 months postoperatively (range, 3–18 months). Definite trabecular reorientation was seen in 69 of the 77 hips (90%) at a mean of 24 months (range, 9–36 months). Trabecular reorientation in grafted bone was apt to be delayed in hips classified as Type IV (Crowe et al.), probably owing to grafting of larger bone bulk in this type (Table 5). The size of the grafted bone mass reduced slightly during followup. Bone mass reduction was recognized within 8 months and the incorporated bone mass was maintained thereafter. On the last radiographs, new radiodense lateral bands were frequent (in 71 hips) (Fig. 7). These bands were present in the region of the original subchondral portion of the femoral head graft.Table 5

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