Stepped osteotomy of femoral head autograft for acetabular reconstruction in total hip arthroplasty for dysplasia of the hip: 3 to 12 years' results

Abstract

Objectives: This study aims to describe a stepped osteotomy technique applied to the femoral head autograft to keep the graft volume at a sufficient level, provide primary stability, and direct cancellous-cancellous bone contact.

Patients and methods: In this retrospective study, 24 hips of 20 patients (5 males, 15 females; mean age 53 years; range, 43 to 68 years) with dysplasia of the hip (DDH) who underwent total hip arthroplasty with femoral head stepped osteotomy technique were evaluated between April 2003 and June 2010. Patients' age, gender, operation side, and postoperative complications were recorded. Aseptic loosening of the acetabular cup and graft integration/resorption were evaluated radiographically. Radiological evaluations were performed according to the methods of DeLee and Charnley, and Mulroy and Harris. Functional status of the patients was determined according to the criteria of Merle d'Aubigné and Postel, and Harris hip score (HHS).

Results: The mean follow-up period was 5.5 years (range, 3 to 12 years). None of the patients had any complications in the early postoperative period. In all patients, the percentage of acetabular component coverage by the graft was measured as 27% (range, 19 to 38%) on average. At the last follow-up, all patients were satisfied with the result and there was no sign of clinically loosening, osteointegration was complete, and there was no radiographic evidence of graft resorption or collapse of any hip. The overall Merle d'Aubigné scores and HHSs of the patients significantly improved at the final follow-up.

Conclusion: This stepped osteotomy technique increases the probability of osteointegration, reduces the need for early revision, and provides reliable stability with satisfactory clinical and radiological midterm results.

Figure 1. Evaluation of acetabular roof graft. [A/(A+B)]x100: Percentage of acetabular component coverage by graft; [B/(A+B)]x100: Percentage of coverage of acetabular component.

Figure 2. (a) Acetabular superolateral insufficiency model. (b) Taking measurements of autograft before stepped osteotomy. (c) Stepped osteotomy. (d) Compression of graft with two screws. (e) Reaming again with large acetabular reamers (graft is more compressed at this stage). (f) Acetabular cup is ready to be placed with adequate coverage.

Figure 3. (a) Preoperative X-ray. (b) Condition of acetabulum after reaming with small reamers. (c) Blue circle shows acetabulum. Area where graft is to be placed (shown by yellow arrow) is ready, spongious bone is fully reached, and sufficient bleeding is provided with drilling. (d) Femoral head autograft prepared by stepped osteotomy is ready to be placed. (e) Compression of graft with screws and reaming process. (f) Acetabular cup and insert are placed. (g) Postoperative X-ray of patient.

Figure 4. (a) Preoperative X-ray. (b) Postoperative 12th year X-ray.

Figure 5. (a) Preoperative X-ray. (b) Postoperative eighth year X-ray (red arrow shows cortical continuity between graft and ilium).

Figure 6. (a) Preoperative X-ray. (b) Postoperative X-ray. (c) Postoperative 11th year X-ray, screw backed out and findings of osteolysis.