Acetabular Revision with Bone Grafting and Cementation for Aseptic Loosening after Primary Charnley Low-Friction Hip Arthroplasty with Structural Bulk Autografts

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 24; no. 3; pp. 328 - 331
• Main Authors: Mohammed, Riazuddin, Drampalos, Efstathios, Siney, Paul, Purbach, Bodo, Kay, Peter
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-12-2016; Sage Publications Ltd; SAGE Publishing
• Subjects: Acetabulum - surgery; Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Autografts; Bone Transplantation; Cementation; Defects; Female; Follow-Up Studies; Fractures, Bone - surgery; Friction; Hip Dislocation - surgery; Hip joint; Hip Prosthesis; Humans; Joint surgery; Male; Middle Aged; Patients; Prosthesis Failure; Reoperation; Skin & tissue grafts; Surgery; Transplantation, Autologous; reoperation; autografts; hip dislocation, congenital; acetabulum
• ISSN: 1022-5536; 2309-4990
• DOI: 10.1177/1602400311

Purpose
To review the outcome of acetabular revision with bone grafting and cementation for aseptic loosening after primary Charnley low-friction hip arthroplasty with structural bulk autografts in 15 patients.
Methods
Records were reviewed for 3 men and 12 women aged 31 to 72 (mean, 53) years who underwent acetabular revision with bone grafting and cementation for aseptic loosening at a mean of 12.4 (range, 6.6–20.3) years after primary Charnley low-friction hip arthroplasty with superolateral structural bulk autografts from the femoral head for dysplastic hip (n=14) or bone loss secondary to acetabular fracture (n=1).
Results
After a mean follow-up of 6.7 (range, 1.1–14.5) years, the mean Merle d'Aubigné and Postel score improved from 8.55 to 16.5. Bridging trabeculae was noted in 10 hips and graft remodelling in 5 hips. Five hips had ectopic ossification of Brooker grade 1 to 2. The mean hip centre of rotation was 21.6 (range, 16.2–30.6) mm. Two women required re-revision for aseptic loosening of the acetabulum after 8.5 and 6.6 years. The first one underwent re-revision with solid allograft for superolateral deficiency of the acetabulum. The second one underwent re-revision with solid and morselised bone allografts for loosened acetabulum. One patient had superior migration of the acetabulum for 9 mm at year 2, but it was asymptomatic. One patient had a dislocation that was reduced with manipulation under anaesthesia. Three patients had trochanteric non-union and presented with lateral thigh pain and tenderness, but no further surgery was performed.
Conclusion
The medium-term outcome of acetabular revision with bone grafting and cementation is satisfactory. Repeat bone grafting is required to restore the anatomic acetabular position and bone loss secondary to acetabular loosening.