Roque BR, Carles HM

Language: Spanish
References: 14
Page: 110-118
PDF size: 164.80 Kb.

ABSTRACT

Introduction: the presence of acetabular protrusion in a patient who will undergo total hip arthroplasty points to greater surgical difficulty, since treatment will require reconstruction of the cavitary defect.
Objective: evaluate the results of treatment of acetabular protrusion with bone grafting of the medial acetabular wall combined with total hip arthroplasty with a cementless acetabular component.
Methods: a prospective longitudinal descriptive study was conducted of 38 patients receiving bone grafts of the medial acetabular wall combined with total hip arthroplasty with a cementless acetabular component from January 2008 to December 2010. Autologous grafts were used in 23 patients and homologous bank bone grafts in 15. The patients were followed up through physical and radiographic examination conducted 4 weeks, 12 weeks, 6 months and 1 year after surgery.
Results: all graft types seemed to incorporate within a period of approximately 3 months. No patient showed protrusion progression during the stage of graft consolidation or later. Harris hip score improved from a preoperative mean of 38 (22-55) to a postoperative mean of 89 (80-95).
Conclusion: acetabular reconstruction with medial wall grafting and a cementless acetabular component provides sufficient bone substrate to extend the useful life of arthroplasty.

REFERENCES

1. Sporer SM, Paprosky W, O'Rourke M. Managing Bone Loss in Acetabular Revision. J Bone Joint Surg Am. 2005;87:1620-30.

2. Schreurs BW, van Tienen TG, Buma P. Favorable results of acetabular reconstruction with impacted morsellized bone grafts in patients younger than 50 years. A 10- to 18-year follow-up study of 34 cemented total hip arthroplasties. Acta Orthop Scand. 2001;72:120.

3. Hansen E, Ries MD. Revision total hip arthroplasty for large medial (protrusio) defects with a rim-fit cementless acetabular component. J Arthroplasty. 2006;21(1):72-79.

4. Welten MLM, Schreurs BW, Buma P. Acetabular reconstruction with impacted morcellized cancellous bone autograft and cemented primary total hip arthroplasty. A 10- to 17-year follow-up study. J Arthroplasty. 2000;15:819.

5. Krushell RJ, Fingeroth RJ., Gelling B. Primary total hip arthroplasty using a dual-geometry cup to treat protrusio acetabuli. J Arthroplasty. 2008;23(8):1128-31.

6. Jones CP, Lachiewicz PF. Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions. J Bone Joint Surg Am. 2004;86-A:342.

7. Schimmel JW, Buma P, Versleyen D, Huiskes R, Slooff TJ. Acetabular reconstruction with impacted morselized cancellous allografts in cemented hip arthroplasty: a histological and biomechanical study on the goat. J Arthroplasty. 1998;13:438-48.

8. Schreurs BW, Bolder SB, Gardeniers JW, Verdonschot N, Slooff TJ, Veth RP. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up. J Bone Joint Surg Br. 2004;86:492-7.

9. Comba F, Buttaro M, Pusso R, Piccaluga F. Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years. International Orthopaedics (SICOT). 2009;33:611-6.

10. Mullaji AB. Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups: a medium-term radiographic review. J Arthroplasty. 2007;22(8):1143-9.

11. Herrera A, Martínez AA, Cuenca J, Canales V. Management of types III and IV acetabular deficiencies with the longitudinal oblong revision cup. J Arthroplasty. 2006;21(6):857-64.

12. Blom AW, Wylde V, Livesey C, Whitehouse MR, Eastaugh-Waring S, Bannister GC, et al. Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute. Acta Orthopaedica. 2009;80(2):150-4.

13. McBride MT, Muldoon MP, Santore RF. Protrusio acetabuli: diagnosis and treatment. J Am Acad Orthop Surg. 2001;9:79.

14. Al Muderis M, Bohling U, Grittner U,Gerdesmeyer L, Scholz J. Cementless total hip arthroplasty using the spongiosa-I fully coated cancellous metal surface: A minimum twenty-year follow-up. J Bone Joint Surg Am. 2011;93:1039-44.