High survivorship of cemented sockets with roof graft for severe acetabular dysplasia

Vincent J J F Busch, Nicholas D Clement, Philipp F J Mayer, Steffen J Breusch, Colin R Howie
Clinical Orthopaedics and related Research 2012, 470 (11): 3032-40

BACKGROUND: Socket fixation in patients with acetabular dysplasia can be technically demanding but the use of structural grafts can help to reconstruct the original center of hip rotation. Because reported survival rates differ, construct survival seems to depend on the technique of graft preparation and fixation.

QUESTIONS/PURPOSES: What is the survivorship of cemented sockets with acetabular roof graft in patients with severe acetabular dysplasia? Do clinical scores equal those of patients without acetabular grafting?

METHODS: We retrospectively reviewed 62 patients (74 hips) who had undergone cemented THA with acetabular roof graft. Mean age at surgery was 45 years (range, 19-71 years). Revisions and radiographic failures were determined and clinical scores (Oxford, SF-12) were obtained and matched to a control group. Kaplan-Meier analysis was used to determine survivorship at a minimum followup of 5 years (mean, 10.4 years; range, 5-16 years).

RESULTS: Survivorship for all-cause revision was 98% (95% CI, 92.5%-100.0%) at 10 years followup. Two hips were revised for aseptic acetabular loosening and one hip for polyethylene wear. All grafts incorporated and no additional radiographic loosenings were seen. Patients with grafting had higher Oxford scores compared with the control group but other scores were equal.

CONCLUSIONS: In contrast to reported series and the common use of cementless cups in patients with developmental dysplasia of the hip, we found high survivorship of cemented sockets with roof graft in severe acetabular dysplasia at a mean followup of more than 10 years. These patients showed higher Oxford scores than patients in a control group. This technique that restores bone stock is a reasonable solution for often young patients with dysplasia.

LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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