use of bone graft in reconstruction of the acetabulum in primary hip replacement

ABSTRACT

Material: Between 1995 and 1998, 28 total hip replacements were performed. Autografting of the acetabulum was performed in all cases. Nineteen patients were females and 9 were males. The youngest patient was 38 years old and the oldest 83. Morselized bone graft was used in 15 hips [53.6%], bone graft and one plate in 8 hips [28.6%] and bone graft and titanium mesh in 5 hips [17.8%]. Acetabular defect was medical cavitary in 15 hips [53.6%], medial cavitary and medial segmental in 3 hips [10.7%], segmental superior in 6 hips [21.5%], segmental superior and anterior in 2 hips [7.1%], and segmental superior and posterior in 2 hips [7.1%]. Method: Posterior approach was used in all cases. Bone graft from the patient's own femoral head was cut into small pieces about 0.5 - 1.0cm manually using bone nibbler after removing the articular cartilage, or as a segment of cortico-cancellous graft. Follow-up period The average follow up period was 3.9 years. The average modified Harris Hip score was 31.7 points and at the end of follow up 69.8. In 26 cases [92.86%] the graft appeared to be incorporated securely to the acetabulum as determined by radiographic examination. There were two failures [7.14%]. In one hip the cup was migrated 22 mm superiorly and the other cup showed upward migration of 8 mm. Femoral head autograft appears to provide a useful technique for the reconstruction of a severely deficient acetabulum during primary hip arthroplasty