ABSTRACT
Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.
ABSTRACT
PURPOSE: The purpose of this study was to analyze the clinical and radiographic results of revision of loose total hip replacements, using proximal femoral allografts and a cemented implant. MATERIAL AND METHODS: We retrospectively reviewed of 28 consecutive patients. Twenty patients were available for study. Each patient was scored using a modified Harris Hip Score. Radiographs were examined for endosteal and periosteal reabsorption, allograft-host union, trochanteric migration, component loosening and heterotrophic calcification. RESULTS: The mean pre-operative Harris hip Score was 34 points. At the latest follow-up, the meanscore was 80 points. Nineteen cases (95%) had combined femoral defects and one patient (5%) had a segmental defect, according to the AAOS classification. Allograft resorption was seen in eight (40%) hips. There were 18 cases (90%) of allograft union, one (5%) of partial union and one (5%) of nonunion. There was one case of trochanteric migration (more than 1 cm). All femoral components were radiographically stable. The reconstruction was considered successful in 18 patients (90%). CONCLUSION: The use of proximal femoral allografts in femoral revision of loose total hip replacements has high survival and satisfactory clinical results at an average period of eight years postoperatively.
