The use of fibre-based demineralised bone matrix in major acetabular reconstruction: surgical technique and preliminary results

Abstract

Acetabular osteolysis associated with socket loosening is one of the main long-term complications of total hip arthroplasty. In case of major bone loss, where <50% host bone coverage can be obtained with a porous-coated cementless cup, it is generally agreed that a metal ring or cage in association with a cemented component and allograft bone should be used. In order to promote allograft bone consolidation and incorporation, we have associated demineralised bone matrix (DBM, Grafton® A Flex) to the construct ion. Here we describe the technical details of major acetabular reconstruction using the Kerboull acetabular reinforcement device with allograft bone and DBM. This device has a hook that must be placed under the teardrop of the acetabulum and a plate for iliac fixation. The main advantages of this device are help in restoring the normal centre of hip rotation, guiding the reconstruction and partially unloading the graft. The Kerboull acetabular reinforcement device has provided a 92% survival rate free of loosening at 13-year follow-up in a consecutive series of 60 type III and IV deficiencies. Our preliminary results using DBM indicate faster allograft consolidation and remodelling.

Fig. 1

Grafton® demineralised bone matrix (DBM) A Flex™ is placed in direct contact with host bone. No fibrous tissue should be interposed between Grafton® DBM A Flex™ and host bone. During placement of the Kerboull device, the inferior hook should be positioned below the inferior margin of the acetabulum and the iliac plate at 40–45° of abduction

Fig. 2

The device is fixed with two to three bicortical 5-mm outer-diameter screws directed towards the sacroiliac joint without reaching it, and 10° posteriorly

Fig. 3

After complete reconstruction of the deficient acetabulum that has become completely contained, an all-polyethylene socket is cemented in the usual postion

Fig. 4

a Preoperative anteroposterior (AP) radiograph of the hip of a 65-year-old woman with a combined structural and cavitary defect involving the acetabular roof and anterior and posterior walls 12 years following primary hybrid total hip arthroplasty. b By 3 months, the demarcation line between allograft and host bone had disappeared. c By 1-year follow-up, allograft remodelling could clearly be seen