Short- and mid-term effectiveness of impaction bone allograft with acetabular components in treatment of severe acetabular defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Leilei ^1,2 , HONG Guoju ^2,3,4 , LIN Tianye ^2,3 , HUANG Linfeng ^2,3 , ZHANG Qingwen ^1,2 ,  HE Wei ^1,2

1. Third Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
2. The Lab of Orthopaedics and Traumatology of Chinese Medicine of Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
3. The First Medical College, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;
4. Devision of Orthopeadic Surgery, the University of Alberta, Canada;

Corresponding author：

HE Wei, Email: hw13802516062@126.com

Keywords：

Hip; revison; acetabular defect; allogeneic bone; impaction bone grafting; joint reconstruction

DOI：

10.7507/1002-1892.201904153

Video：

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Objective To investigate the short- and mid-term effectiveness of revision hip arthroplasty by using impaction bone allograft and acetabular components in treatment of severe acetabular defects.Methods A clinical data of 42 patients (44 hips) with severe acetabular defects between February 2011 and May 2018 were retrospectively analyzed. All patients underwent revision hip arthroplasty by using impaction bone allograft and acetabular components. Cemented cup (24 cases, 24 hips) and non-cemented cup (18 cases, 20 hips) were used in the revision surgery. There were 17 males and 25 females with an average age of 62.8 years (range, 22-84 years). The interval between the first total hip arthroplasty and revision was 2.5-12.0 years (mean, 8.3 years). The patients were accepted revision surgery for prosthesis aseptic loosening in 32 hips (31 cases) and the periprosthetic infection in 12 hips (11 cases). Twenty-nine hips (28 cases) were Paprosky type ⅢA and 15 hips (14 cases) were type ⅢB. The preoperative Harris score was 22.25±10.31 and the height of hip rotation center was (3.67±0.63) cm and the length difference of lower limbs was (3.41±0.64) cm.Results The operation time was 130-245 minutes (mean, 186 minutes) and the intraoperative blood loss was 600-2 400 mL (mean, 840 mL). The postoperative drainage volume was 250-1 450 mL (mean, 556 mL). Superficial infection of the incision occurred in 1 case, and the incisions healed by first intention in the other patients. All patients were followed up 6-87 months, with an average of 48.6 months. At last follow-up, the Harris score was 85.85±9.31, which was significantly different from the preoperative score (t=18.563, P=0.000). Imaging examination revealed that the allogeneic bone gradually fused with the host bone, and no obvious bone resorption was observed. At last follow-up, the height of the hip rotation center was (1.01±0.21) cm, which was significantly different from the preoperative level (t=17.549, P=0.000); the length difference of lower limbs was (0.62±0.51) cm, which was significantly different from the preoperative level (t=14.211, P=0.000). The Harris score in the cemented group and non-cemented group increased significantly at last follow-up. The height of the hip rotation center decreased, and the hip rotation centers of both groups were within the Ranawat triangle zone. The length difference of the lower limbs also decreased, and the differences in all indexes were significant between pre- and post-operation (P<0.05). There was significant difference in the height of the hip rotation center between groups (t=2.095, P=0.042), but there was no significant difference in the Harris score and the length difference of lower limbs between groups (P>0.05).Conclusion For severe acetabular defect (Paprosky type Ⅲ), the hip can be reconstructed with the impaction bone allograft and cemented or non-cemented components in revision hip arthroplsty. The short- and mid-term effectiveness are satisfactory.

Citation： CHEN Leilei, HONG Guoju, LIN Tianye, HUANG Linfeng, ZHANG Qingwen, HE Wei. Short- and mid-term effectiveness of impaction bone allograft with acetabular components in treatment of severe acetabular defects. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 341-346. doi: 10.7507/1002-1892.201904153 Copy

1.	Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res, 2013, 471(11): 3725-3730.
2.	Kim YH. Acetabular cup revision. Hip Pelvis, 2017, 29(3): 155-158.
3.	Sporer SM. How to do a revision total hip arthroplasty: revision of the acetabulum. Instr Course Lect, 2012, 61: 303-311.
4.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
5.	Sheth NP, Nelson CL, Springer BD, et al. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg, 2013, 21(3): 128-139.
6.	Waddell BS, Boettner F, Gonzalez Della Valle A. Favorable early results of impaction bone grafting with reinforcement mesh for the treatment of Paprosky 3B acetabular defects. J Arthroplasty, 2017, 32(3): 919-923.
7.	Waddell BS, Della Valle AG. Reconstruction of non-contained acetabular defects with impaction grafting, a reinforcement mesh and a cemented polyethylene acetabular component. Bone Joint J, 2017, 99-b(1 Supple A)): 25-30.
8.	Busch VJ, Gardeniers JW, Verdonschot N, et al. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg (Am), 2011, 93(4): 367-371.
9.	Subramanian S, Jain KD, Sreekumar R, et al. Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements. Ann R Coll Surg Engl, 2010, 92(1): 27-30.
10.	Drampalos E, Fadulelmola A, Mohammed R, et al. Nine-year results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacement. Ann R Coll Surg Engl, 2017, 99(3): 203-206.
11.	Ullmark G. Bigger size and defatting of bone chips will increase cup stability. Arch Orthop Trauma Surg, 2000, 120(7-8): 445-447.
12.	孙正, 周建生. 异体松质骨植骨打压紧密度对植骨转归影响的实验研究. 解剖与临床杂志, 2012, 7(5): 377-380.
13.	Comba F, Buttaro M, Puuso R, et al. Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years. Int Orthop, 2009, 33(3): 611-666.
14.	García-Rey E, Madero R, García-Cimbrelo E. THA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects. Clin Orthop Relat Res, 2015, 473(12): 3882-3891.
15.	Shibuya N, Jupiter DC. Bone graft substitute: allograft and xenograft. Clin Podiatr Med Surg, 2015, 32(1): 21-34.
16.	van der Donk S, Weernink T, Buma P, et al. Rinsing morselized allografts improves bone and tissue ingrowth. Clin Orthop Relat Res, 2003, (408): 302-310.
17.	Colo E, Rijnen WH, Schreurs BW. The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup. Hip Int, 2015, 25(4): 361-367.
18.	Kokubo Y, Oki H, Sugita D, et al. Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices. Eur J Orthop Surg Traumatol, 2016, 26(4): 407-413.
19.	Abdulkarim A, Ellanti P, Motterlini N, et al. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia), 2013, 5(1): e8.
20.	Commen AT, Krishnamoorthy VP, Poonnoose PM, et al. Fate of bone grafting for acetabular defects in total hip replacement. Indian J Orthop, 2015, 49(2): 181-186.
21.	Haverkamp D, De Man FH, Siegt R, et al. Cemented hip revision surgery in severe acetabular defects using a semirigid acetabular reinforcement ring—a 5- to 25-year follow-up study. J Arthroplasty, 2009, 24(2): 246-255.
22.	陈哲峰, 范卫民, 王青, 等. 同种异体颗粒骨打压植骨钛网杯重建髋臼骨缺损的疗效. 中华骨科杂志, 2016, 36(23): 1512-1516.

1. Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res, 2013, 471(11): 3725-3730.
2. Kim YH. Acetabular cup revision. Hip Pelvis, 2017, 29(3): 155-158.
3. Sporer SM. How to do a revision total hip arthroplasty: revision of the acetabulum. Instr Course Lect, 2012, 61: 303-311.
4. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-44.
5. Sheth NP, Nelson CL, Springer BD, et al. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg, 2013, 21(3): 128-139.
6. Waddell BS, Boettner F, Gonzalez Della Valle A. Favorable early results of impaction bone grafting with reinforcement mesh for the treatment of Paprosky 3B acetabular defects. J Arthroplasty, 2017, 32(3): 919-923.
7. Waddell BS, Della Valle AG. Reconstruction of non-contained acetabular defects with impaction grafting, a reinforcement mesh and a cemented polyethylene acetabular component. Bone Joint J, 2017, 99-b(1 Supple A)): 25-30.
8. Busch VJ, Gardeniers JW, Verdonschot N, et al. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg (Am), 2011, 93(4): 367-371.
9. Subramanian S, Jain KD, Sreekumar R, et al. Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements. Ann R Coll Surg Engl, 2010, 92(1): 27-30.
10. Drampalos E, Fadulelmola A, Mohammed R, et al. Nine-year results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacement. Ann R Coll Surg Engl, 2017, 99(3): 203-206.
11. Ullmark G. Bigger size and defatting of bone chips will increase cup stability. Arch Orthop Trauma Surg, 2000, 120(7-8): 445-447.
12. 孙正, 周建生. 异体松质骨植骨打压紧密度对植骨转归影响的实验研究. 解剖与临床杂志, 2012, 7(5): 377-380.
13. Comba F, Buttaro M, Puuso R, et al. Acetabular revision surgery with impacted bone allografts and cemented cups in patients younger than 55 years. Int Orthop, 2009, 33(3): 611-666.
14. García-Rey E, Madero R, García-Cimbrelo E. THA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects. Clin Orthop Relat Res, 2015, 473(12): 3882-3891.
15. Shibuya N, Jupiter DC. Bone graft substitute: allograft and xenograft. Clin Podiatr Med Surg, 2015, 32(1): 21-34.
16. van der Donk S, Weernink T, Buma P, et al. Rinsing morselized allografts improves bone and tissue ingrowth. Clin Orthop Relat Res, 2003, (408): 302-310.
17. Colo E, Rijnen WH, Schreurs BW. The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup. Hip Int, 2015, 25(4): 361-367.
18. Kokubo Y, Oki H, Sugita D, et al. Long-term clinical outcome of acetabular cup revision surgery: comparison of cemented cups, cementless cups, and cemented cups with reinforcement devices. Eur J Orthop Surg Traumatol, 2016, 26(4): 407-413.
19. Abdulkarim A, Ellanti P, Motterlini N, et al. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev (Pavia), 2013, 5(1): e8.
20. Commen AT, Krishnamoorthy VP, Poonnoose PM, et al. Fate of bone grafting for acetabular defects in total hip replacement. Indian J Orthop, 2015, 49(2): 181-186.
21. Haverkamp D, De Man FH, Siegt R, et al. Cemented hip revision surgery in severe acetabular defects using a semirigid acetabular reinforcement ring—a 5- to 25-year follow-up study. J Arthroplasty, 2009, 24(2): 246-255.
22. 陈哲峰, 范卫民, 王青, 等. 同种异体颗粒骨打压植骨钛网杯重建髋臼骨缺损的疗效. 中华骨科杂志, 2016, 36(23): 1512-1516.

Chinese Journal of Reparative and Reconstructive Surgery

Short- and mid-term effectiveness of impaction bone allograft with acetabular components in treatment of severe acetabular defects

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