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. 2009 Jun;33(3):611-6.
doi: 10.1007/s00264-007-0503-x. Epub 2008 Feb 9.

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

Fernando Comba  1 , Martín Buttaro, Rodolfo Pusso, Francisco Piccaluga
Affiliations

Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years

Fernando Comba et al. Int Orthop. 2009 Jun.

Abstract
in English, French

This article summarises a clinical and radiographical analysis of 30 acetabular revisions in patients younger than 55 years old, performed with impaction bone grafting and cemented cups. Preoperative Merle D'Aubigne and Postel functional score was an average 7 points. At a mean follow-up of 86.5 months (range 34-228) functional score averaged 16.3 points. Radiolucent lines with no clinical impact were observed in 7% of DeLee and Charnley acetabular zones evaluated. Massive radiological migration, consistent with clinical failure, was observed in two cups. Three patients underwent re-revision surgery (10%): two due to infection and one due to mechanical failure. Reconstruction survival rate was 89% (CI 95% 71.9-96.4) overall, and 96% (CI 95% 82.6-99.3) ruling out cases of infection. Impacted bone allograft constitutes one of the reconstructive techniques of choice in acetabular revision surgery of young patients. Restoration of bone stock is essential in this group of patients due to the possibility of future revisions.

Nous avons analysé cliniquement et radiographiquement 30 révisions acétabulaires chez des patients jeunes âgés de moins de 55 ans, révision réalisée avec une greffe impactée et une cup cimentée. Le score pré-opératoire de Postel Merle d’Aubigné était en moyenne à 7 points. Après un suivi moyen de 86,5 mois (de 34 à 228 mois) le score post-opératoire de Postel Merle d’Aubigné était en moyenne à 16,3 points. Des liserés sans traduction clinique ont été observés dans 7% des cas et analysés selon DeLee et Charnley. Une migration massive radiographique avec un échec clinique a été observé dans deux cas. 3 patients ont nécessité une nouvelle révision (10%), 2 pour infection et 1 pour échec clinique. Le taux de survie de cette reconstruction a été de 89% (intervalle de confiance 95% 71.9–96.4) et de 96% (intervalle de confiance 95% 82.6–99.3) pour les cas d’infection. L’allogreffe impactée constitue une technique de choix pour la reconstruction lors d’une révision acétabulaire chez des patients jeunes. La restauration du stock osseux est essentielle dans ce groupe de patients et permet d’anticiper de futures révisions.

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Figures

Fig. 1
Fig. 1
Survival curve showing the Kaplan–Meier analysis with the need for a further revision concerning the end point
Fig. 2
Fig. 2
a A-P X-ray of a female patient with aseptic loosening of a cemented first revision of a THA. b Four years after reconstruction the X-rays show a stable reconstruction with the host bone and the grafts with similar bone density
See this image and copyright information in PMC

References

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