Acetabular Revision Using Cementless Acetabular Cup

PURPOSE: To evaluate implant survivorship and clinical outcomes after acetabular revision using cementless acetabular cups. MATERIALS AND METHODS: We evaluated 27 cementless acetabular revision cases performed between January 1998 and October 2005. All patients were followed up for more than 2 years, and the mean follow-up period was 54.1 months (range: 24~120 months). In all cases, morselized allografting was performed. Five cases needed structural allografting to achieve stability of the acetabular cup. The clinical results were analyzed using the Harris hip score, and radiological analysis was performed for evaluation of radiolucent lines, osteolysis, loosening, and changes in the hip center. RESULTS: At the time of latest follow-up, no cups showed failure requiring re-revision. The average Harris hip score improved from 67.1 points preoperatively to 91.4 points postoperatively. Radiologically, 7 cases (25.9%) showed radiolucent lines around the acetabular cup, but there was no loosening or osteolysis. CONCLUSION: Cementless acetabular revision showed satisfactory radiological and clinical results on short-term follow-up analysis. Even in cases with considerable amounts of acetabular bone loss, stable fixation could be obtained with structural bone grafting.

Revision Total Hip Arthroplasty using Morselized Femoral Head Allograft and Cementless Cup in Acetabular Bone Deficiency / 대한정형외과학회잡지

PURPOSE: This study was aimed to evaluate the clinical and radiologic results of revision total hip arthroplasty using a cementless cup and a morselized femoral head allograft in acetabular bone deficiency. MATERIALS AND METHODS: From January 1992 to December 1999, the authors performed 37 revision total hip arthroplasties using morselized femoral head allografts and cementless cup. This study evaluated the clinical and radiologic results, at a mean follow-up of 50 months. We evaluated the Harris hip score clinically, and the displacement of acetabular cup by Yoder's criteria. Location and progression of radiolucent area within acetabular zone, which was defined by DeLee and Charnley was observed and recorded. RESULTS: Mean Harris hip score was improved from 50.6 preoperative to 89.2 at final follow-up. A radiolucent zone between host bone and graft bone was observed in 5 cases, and between graft bone and cup in 7 cases, but all of these were less than 2 mm. The change of cup angle more than 4 degrees were observed in 3 cases in Gross type 4, 4 mm superior migration of acetabular cup was observed in 1 case in Gross type 3 and 5 mm horizontal migration was observed in 1 case in Gross type 4. CONCLUSION: Although the early results in revision total hip arthroplasty have been encouraging to date except for Gross type 4, a more long term follow-up study with a larger size cases are needed.

Revision Total Hip Arthroplasty Using Cementless Acetabular Cup / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of revision total hip arthroplasty using cemetless acetabular cup and several kinds of morseled bone grafts. MATERIALS AND METHODS: We performed 20 cases of revision total hip arthroplasties between July 1993 and June 1996. Acetabular bone deficiency was classified as type I in 4 hips, type II in 13 hips, type III in 2 hips and type IV in one hip by AAOS classification. Autogenous bone graft was used in 10 cases, heterograft in 5 cases, allograft in 2 cases and a mixture with autografts and allografts in 2 cases. The average contact rate between cup and host bone was 33.5% in type I acetabular deficiency, 65.1% in type II, 50% in type III and 39% in type IV. RESULTS: The mean Harris hip score was 82.9 points at the last follow-up. Osseous union between host bone and graft bone occurred within 6 months in 14 cases. Radiological failure was noted in 8 cases at the last follow-up. Three cases were revised during the follow-up period. Five cases out of 7 cases in which the contact rate between acetabular cup and host bone was less than 50% were determined to be a radiologic failure. Only 2 cases of the 10 cases in which autogenous bone graft had failed grafts. The rate of complication was 7cases (35%). CONCLUSIONS: The usage of the hemispherical cementless acetabular cup with autogenous bone graft and increasing the contact rate between the acetabular cup and host bone could be a safe management method in revision total hip arthroplasty. We recomrnend avoiding the use of heterograft in cementless cup revision arthroplasty.