[Structural femoral head allografts in revision surgery of loosened acetabular cups]

Abstract

Background: Treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). Many methods of acetabular reconstruction have been described. The purpose of this study was to evaluate the midterm results of structural femoral head allografts for acetabular reconstruction.

Methods: Thirty-six patients (33 females and 3 males) with acetabular defects ranging from type 2C to type 3B according to Paprosky's classification were included in the study. In all cases acetabular defects were closed using allografts from femoral heads. In 13 cases an uncemented press-fit cup, in 17 cases a cemented polyethylene socket, and in 6 cases a Burch-Schneider antiprotrusion cage was implanted. The mean follow-up period was 84.2 months (range: 5-147).

Results: Four acetabular components failed. All 36 grafts were osseointegrated radiographically and formed a mechanically stable construction. The mean Harris Hip Score at the most recent follow-up was 79.8 points. The distance from the obturator line to the prosthesis head center was 3.73 cm (1.17-5.80 cm) preoperatively and 2.79 cm (0.85-4.8 cm) postoperatively (p<0.05). The distance from the teardrop figure to the prosthesis head center was 3.02 cm (1.0-5.8 cm) preoperatively and 3.25 cm (1.6-4.8 cm) postoperatively (p<0.001).

Conclusions: Closure of acetabular defects of types 2C to 3B according to Paprosky's classification can be satisfactorily accomplished using femoral head allografts. These allografts may facilitate future revision surgery. Femoral heads are readily available due to widespread primary total hip replacement surgery. However, the use of structural femoral head allografts for acetabular reconstruction is cost intensive. Individual patient-related aspects, such as the function of revision arthroplasty, have to be considered when planning revision arthroplasty using femoral head allografts.