Impaction bone grafting with morselized bone in total hip revision for acetabular deficiency / 中国组织工程研究

BACKGROUND:Bone graft for acetabular reconstruction includes morselized bone graft, structural bone graft and hybrid bone graft, and the morselized bone has been widely used because of the advantages of simple production and short healing time. OBJECTIVE:To explore the key technologies and clinical effect of impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency. METHODS:Sixteen cases of AAOS Ⅲ acetabular deficiency were treated with impaction bone grafting with morselized bone combined with metal devicesor constructive bone grafting. The hip Harris scores and radiographic data were compared before and after treatment. The effect of impaction bone grafting with morselized bone on acetabular deficiency was assessed. RESULTS AND CONCLUSION:Al the patients were fol owed-up at 3, 6, 12 months after surgery and every half a year successively. The pain of hip joints after operation was relieved significantly and the walking function was restored. The hip Harris score was improved from 48.00 points before surgery to 84.94 points after surgery (Pacetabular cup prosthesis did not displaced, and no displacement and breakage happened to the metal devices. Impaction bone grafting with morselized bone in total hip revision for AAOS Ⅲ acetabular deficiency can effectively reconstruct the acetabular bone structure, retain and restore the acetabular bone mass, and it has good technical advantages and good clinical effects.

Risk Factors Related to Modular Femoral Stem Failures in Revision Hip Arthroplasty / 대한고관절학회지

PURPOSE: The purpose of this study was to analyze failure rates and causes of hip arthroplasty revisions associated with the use of cementless modular femoral stems. MATERIALS AND METHODS: This study comprised 93 patients(100 hips) that were followed up for more than two years after revision involving modular femoral stem arthroplasty. The clinical results were evaluated using the Harris Hip Score and the radiologic results were evaluated using leg length discrepancy, subsidence and bone formation assessments. We analyzed the relationship between the number of hip surgeries performed and the bone deficiencies and failures observed. Preoperative femoral bone deficiencies were described by Paprosky Grade; Grade I or II were identified in 24 hips, IIIa in 4 hips, IIIb in 28 hips and IV in 3 hips. RESULTS: We observed 80 hips with aseptic loosening, 10 hips with infection after previous revision, 8 hips with periprosthetic fractures and 2 hips with dislocations. Clinical results improved from a preoperative score of 42 (HHS) to a postoperative mean score of 81.5. The cause of early failure in 4 hips was identified as femoral stem subsidence, and the cause of late failure in 3 hips was due to infection. According to the comparison analysis, there was no statistical significance between femoral bone deficiency (P=0.727) and application of cement (P=0.087), but hips with previous revision surgery showed a higher rate of failure (P=0.024). CONCLUSION: Cementless modular stems produced satisfactory results. The main cause of failure was subsidence. A significant risk factor for failure was hips which had undergone previous revision surgery.

Revision of total Hip Arthroplasty Using Allogenic Bone Graft in Acetabular Deficiency / 대한정형외과학회잡지

Patients with severe acetabular bony deficiency in total hip revision arthroplasties need the use of autogenous or allogenic bone grafts. The Authors performed 28 cases of total hip revision arthroplasties between June 1991 and January 1995 with femoral head allograft for acetabular bony deficiencies and evaluated the clinical and radiological results according to AAOS classification. The clinical result was evaluated by D'Aubigne and Postel score. The mean score was improved from 3.9 points to 5.1 points at follow-up. In radiological evaluation, osseous union of graft was achieved within 12 month and rerevision were performed in two cases (92.8% survival rates) but radiological radiolucent line in at least one zone was seen in five hips in two year follow up. In conclusion, the results of hemispherical microporocoat cup with allogenic bone in segmental or cavitary defect using with acetabular reinforcement ring in combined deficiency were encouraging to date. Success rate of allograft reconsruction of the acetabulum results from a variety of acetabular defect. In our studies, only 40% showed stable bony fixation over short period.