T.J.J.H. Slooff

Acetabular reconstruction with impacted morsellised cancellous bone graft and cement: A 10- to 15-year follow-up of 60 revision arthroplasties

We report a long-term review of 60 acetabular components revised using impacted, morsellised bone allografts and a cemented polyethylene cup. The acetabular defects were cavitary (37) or combined (23). Follow-up was for a mean 11.8 years (10 to 15). Further revision was needed in five hips, two for septic and three for aseptic loosening. The overall survival rate at 11.8 years was 90%; excluding the septic cases it was 94%. Acetabular reconstruction with impacted morsellised cancellous grafts and cement gives satisfactory long-term results.

Acetabular Reconstruction with Impaction Bone-Grafting and a Cemented Cup in Patients Younger Than Fifty Years Old

In a previous report, we presented our results of forty-two acetabular reconstructions, performed with use of impaction bone-grafting and a cemented polyethylene cup, in thirty-seven patients who were younger than fifty years and had a minimum of fifteen years of follow-up. The present update study shows the results after twenty to twenty-eight years. Eight additional cups had to be revised--four because of aseptic loosening, three because of wear, and one during a revision of the stem. Three additional cups were considered loose on radiographs. Survivorship of the acetabular reconstructions, with an end point of revision for any reason, was 73% after twenty years and 52% after twenty-five years. With revision for aseptic loosening as the end point, survival was 85% after twenty years and 77% after twenty-five years; for signs of loosening on radiographs, survival was 71% at twenty years and 62% at twenty-five years. In conclusion, our previous results have declined but the technique of using impacted morselized bone graft and a cemented cup is useful for the purpose of restoring bone stock in young patients whose acetabular defects require primary or revision total hip arthroplasty.

Impacted morsellized bone grafting and cemented primary total hip arthroplasty for acetabular protrusion in patients with rheumatoid arthritis.

Between 1979 and 1989, we performed 36 primary total hip replacements in 31 rheumatoid arthritis patients with protrusio acetabuli. The deficient acetabulum was reconstructed with autologous morsellized bone grafts from the femoral head. 3 patients were lost to follow-up. 12 patients (13 hips) died within 8 years postoperatively, none had a revision. 16 patients (20 hips) were reviewed at an average follow-up of 12 (8-18) years. In 2 hips, a revision was performed for aseptic loosening of the acetabular component, 6.5 and 8 years after primary surgery, which means a 90% (95% CI: 77%-100%) survival rate at 12 years (Kaplan Meier analysis). This technique is a good option in cases with protrusio acetabuli due to rheumatoid arthritis.

Acetabular Revision with Impacted Morselized Cancellous Bone Graft and a Cemented Cup in Patients with Rheumatoid Arthritis A Concise Follow-up, at Eight to Nineteen Years, of a Previous Report*

Background: Acetabular revision in patients with rheumatoid arthritis is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup.Methods: Thirty-five consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with rheumatoid arthritis. The average age at the revision was fifty-seven years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 7.5 years; range, three to fourteen years). No patient was lost to follow-up, but five patients (six hips) died before the time of the review. The acetabular bone defects were classified as cavitary in twelve hips and as combined segmental-cavitary in twenty-three.Results: The five patients (six hips) who died had been doing well at the time of their latest follow-up. Of the remaining patients, six (six hips) had a repeat revision. The average Harris hip score of the living patients with a surviving implant at the time of follow-up was 82 points, and there was no or only mild pain in twenty-one of the twenty-three hips. Radiographic analysis of all twenty-nine hips that had not been revised showed loosening in one hip and a nonprogressive radiolucent line in one zone in two others. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 90% at eight years.Conclusion: Acetabular revision with impaction bone-grafting and a cemented cup in patients with rheumatoid arthritis had acceptable results at an average of 7.5 years postoperatively.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Bone impaction grafting and a cemented cup after acetabular fracture at 3-18 years.

The outcome of total hip arthroplasty after acetabular fracture is compromised. We studied if the bone impaction grafting technique could provide long-term prosthesis survival in deformed and irregular acetabula. We studied 20 hips in 20 patients (mean age, 53.3 years; range, 35-75 years) that were reconstructed with acetabular bone impaction grafting and a cemented total hip prosthesis after acetabular fracture. No patient was lost to followup. At review the mean followup was 9.5 years (range, 3-18 years) and the average Harris hip score was 93 (range, 62-100). During followup there were two cup revisions: one after 14.5 years for septic loosening, and one after 15.3 years for aseptic loosening. The Kaplan-Meier survival rate of the cup with end-point revision for any reason was 100% at 10 years and 80% (95% CI; range, 62-98%) after 15 years. With end-point cup revision for aseptic loosening the survival rate was 100% at 10 years. Acetabular bone impaction grafting with a cemented cup is a biologically attractive technique with good long-term survival used to reconstruct bone stock loss after posttraumatic arthritis. The complication and reoperation rate was low in this relatively young group of patients. Level of Evidence: Therapeutic study, Level IV (Case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis: three to fourteen-year follow-up.

BACKGROUNDnAcetabular revision in patients with rheumatoid arthritis is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup.nnnMETHODSnThirty-five consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with rheumatoid arthritis. The average age at the revision was fifty-seven years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 7.5 years; range, three to fourteen years). No patient was lost to follow-up, but five patients (six hips) died before the time of the review. The acetabular bone defects were classified as cavitary in twelve hips and as combined segmental-cavitary in twenty-three.nnnRESULTSnThe five patients (six hips) who died had been doing well at the time of their latest follow-up. Of the remaining patients, six (six hips) had a repeat revision. The average Harris hip score of the living patients with a surviving implant at the time of follow-up was 82 points, and there was no or only mild pain in twenty-one of the twenty-three hips. Radiographic analysis of all twenty-nine hips that had not been revised showed loosening in one hip and a nonprogressive radiolucent line in one zone in two others. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 90% at eight years.nnnCONCLUSIONnAcetabular revision with impaction bone-grafting and a cemented cup in patients with rheumatoid arthritis had acceptable results at an average of 7.5 years postoperatively.

Bone grafting in cemented knee replacement - 45 primary and secondary cases followed for 2-5 years

From 1989 through 1993, we treated 36 knees in 30 patients by bone grafting (31 tibial and 14 femoral grafts) and a cemented total knee prosthesis. We used 23 morsellized and 22 solid bone grafts. After a mean follow-up period of 3 years, the mean clinical (IKS) knee score was 90. Radiographic signs of incorporation of the tibial bone graft were noted in 28 cases. Of the 8 solid femoral bone grafts, we observed twice a disintegration of the graft.

Cemented hip designs are a reasonable option in young patients.

BackgroundYoung patients with degenerative cartilage disease of the hip remain a challenge for the orthopaedic surgeon. Different treatment options are available of which uncemented hips are the most popular owing to long-term concerns about cemented implants. As an alternative, we have used a cemented hip design in combination with bone impaction grafting in patients with acetabular defects.Questions/purposesWe therefore determined the survival rates and radiological failures of cemented THA in patients younger than 30xa0years and reported clinical scores, complications and current state of the revised THAs.MethodsWe retrospectively reviewed all 48 patients (69 hips) younger than 30xa0years at the time of surgery who had a primary cemented THA performed between 1988 and 2004. Acetabular defects were reconstructed using bone impaction grafting in 29 hips. Mean age at surgery was 24.6xa0years (range, 16–29xa0years). Revisions were documented, radiographs were analyzed, and the Kaplan-Meier method was used to determine survival for different end points. No patient was lost to followup, three patients (four hips) had died. Minimum followup was 2xa0years (mean, 8.4xa0years; range, 2–18xa0years).ResultsEight hips were revised (three for infection and five for aseptic loosening) and one hip dislocated for which open reduction was necessary. One additional cup was considered a radiographic failure. The 10-year survival was 83% (95% confidence interval, 69%–92%) with revision for any reason as the end point and 90% (95% confidence interval, 77%–96%) with revision for aseptic loosening.ConclusionsWe found a high survival rate of these cemented THA in young patients. In young patients with acetabular bone defects we recommend reconstruction using cemented implants with bone impaction grafting.Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.