[Results of acetabular reconstruction with solid bone graft in primary and revision hip arthroplasty].

PURPOSE OF THE STUDY: To evaluate the results of acetabular reconstruction in total hip replacement and to compare them in view of the use of autologous or allogenic solid bone grafts.

MATERIAL AND METHODS: The author evaluates a group of 48 total hip replacements carried out in the years 1990-1999, in which solid bone graft was used for reconstruction of an insufficient acetabulum. In 25 hips, the patient's own femoral head was used in primary surgery and, in 23 hips, a frozen femoral head from a tissue bank was used in revision arthroplasty. Most of the acetabular components used in this study were cemented. The patients were evaluated at 5- to 15-year follow-up. Each group was assessed separately and the results were divided into three categories according to X-ray and intra-operative findings, as follows: I. No radiographic evidence of cup loosening and incorporated graft II. Loosened cup and incorporated graft suitable for use in reimplantation III. Loosened cup and graft non-union or resorption

RESULTS: In the autograft group, 80 % of the patients fell in category I and 12 % in category II; in the allograft group, 82 % of the patients were in category I and 9 % in category II. Complete failure, i.e., graft resorption and acetabular loosening, was recorded in 8 % and 9 % of group I and group II patients, respectively. Biopsy samples obtained during revision hip surgery showed good incorporation of both autografts and allografts.

DISCUSSION: Other authors' views on the function of solid bone grafts after implantation and on methods of treating a defective acetabulum are discussed. The author puts the good outcomes shown in this study down to a careful implantation technique and thorough preoperative planning.

CONCLUSIONS: By using a solid graft, the surgeon will achieve good primary fixation of a standard hip socket in a defective acetabulum and will make conditions for repair of defective bone tissue. The results imply that incorporation of both graft and acetabular component can be expected regardless of whether the graft is fresh or frozen. Although this method has its drawbacks and contraindications, it should be considered one of the options when planning total hip arthroplasty for an insufficient acetabulum.