Revision total hip replacement in severe acetabular bone deficiency

Acetabular bone deficiency is one of the main problems in hip revision. The aim of this study is to evaluate the results of revision hip replacement using stemmed acetabular component. Twenty one hips in 18 patients had revision total hip replacement using the stemmed acetabular reinforcement ring and impaction grafting technique for reconstruction of type III [combined segmental / cavitary] acetabular bone deficiency. A new method of measurements of migration was developed using a personal computer, scanner and a new software [Roman] developed in Robert Jones and Agnus Hunt Orthopaedic Institute, Oswestry, United Kingdom. The overall results revealed satisfactory results in 18 hips [90%] after a mean period of follow-up of 3.8 years. Failure was in 2 cases [10%] due to infection. The mean postoperative hip score improved from 50 points to 87.3 points. The mean vertical migration was 4.57 mm while the mean horizontal migration was 4.11 mm. 2 patients showed significant radiolucent lines and the cup was considered loose. 4 hips [19%] showed grade I heterotopic ossification [HO], one hip [5%] showed grade II HO. and one [5%] had grade III HO. 16 hips [76%] showed complete incorporation of the bone graft. Two hips [10%] had deep infection and considered clinical and radiological failure. Five hips had post operative dislocation and were managed conservatively without the need for any surgical intervention

Conversion from hemiarthroplasty to total HIP replacement: problems and early outcome

Conversion of hemi to total hip replacement [CTHR] is a common but difficult operation. The aim of this study is to evaluate the results of CTHR using long stem femoral prosthesis with or without bone grafting for the acetabulum. Thirty four hemiarthroplasty in 34 patients aged between 54 and 67 years old were converted to total hip arthroplasty. The mean period of follow up was 33 months. The indication of hemiarthroplasty was fracture neck of femur in all cases. There were 20 cemented Thomson and 14 Austin Moore prostheses. Pain was the main indication for conversion arthroplasty. Two types of cemented longstem femoral prostheses were used. Acetabular impaction morselized bone grafting was needed in four cases two of them had reconstruction rings. The mean Harris hip score improved significantly from 55 to 87.3 points. There was high incidence of significant radiolucent lines at the distal end of the stem [47%]. Two failures happened due to infection and recurrent dislocation. We had many intraoperative femoral fracture [18%] but with no direct effect on the results at the last follow-up. We concluded that conversion arthroplasty is a high risk operation but with high success rate. Infection and recurrent dislocation are the most difficult complications to manage. The use of longstem is very helpful but distal cementation technique need to improve