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International Orthopaedics

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01-09-2015 | Original Paper

Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion

Authors: Sándor-György Zuh, Ancuţa Zazgyva, István Gergely, Tudor Sorin Pop

Published in: International Orthopaedics | Issue 9/2015

Abstract

Purpose

This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall.

Methods

The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up.

Results

A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4 % of cases, without clinical evidence of hip mobility impairment or pain.

Conclusions

Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.

Mullaji AB, Shetty GM (2013) Acetabular protrusio: surgical technique of dealing with a problem in depth. Bone Joint J 95-B(11 Suppl A):37–40. doi:10.1302/0301-620X.95B11.32900 CrossRefPubMed

Mullaji AB, Marawar SV (2007) Primary total hip arthroplasty in protrusio acetabuli using impacted morsellized bone grafting and cementless cups: a medium-term radiographic review. J Arthroplasty 22(8):1143–1149. doi:10.1016/j.arth.2006.11.005 CrossRefPubMed

Baghdadi YM, Larson AN, Sierra RJ (2015) Long-term results of the uncemented acetabular component in a primary total hip arthroplasty performed for protrusio acetabuli: a fifteen year median follow-up. Int Orthop 39(5):839–845. doi:10.1007/s00264-014-2580-y CrossRefPubMed

Sotelo-Garza A, Charnley J (1978) The results of Charnley arthroplasty of hip performed for protrusio acetabuli. Clin Orthop Relat Res 132:12–18PubMed

Pierchon F, Migaud H, Duquennoy A, Fontaine C (1993) Radiologic evaluation of the rotation center of the hip. Rev Chir Orthop Reparatrice Appar Mot 79(4):281–284PubMed

Patil N, Hwang K, Goodman SB (2012) Cancellous impaction bone grafting of acetabular defects in complex primary and revision total hip arthroplasty. Orthopedics 35(3):e306–e312. doi:10.3928/01477447-20120222-24 PubMed

Pereira GC, Kubiak EN, Levine B, Chen FS, Di Cesare PE (2007) Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups. Int Orthop 31(4):445–450. doi:10.1007/s00264-006-0220-x PubMedCentralCrossRefPubMed

Bicanic G, Delimar D, Delimar M, Pecina M (2009) Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop 33(2):397–402. doi:10.1007/s00264-008-0683-z PubMedCentralCrossRefPubMed

Traina F, De Fine M, Biondi F, Tassinari E, Galvani A, Toni A (2009) The influence of the centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop 33(6):1513–1518. doi:10.1007/s00264-008-0710-0 PubMedCentralCrossRefPubMed

10.

Bonnin MP, Archbold PH, Basiglini L, Fessy MH, Beverland DE (2012) Do we medialise the hip centre of rotation in total hip arthroplasty? Influence of acetabular offset and surgical technique. Hip Int 22(4):371–378. doi:10.5301/HIP.2012.9350 CrossRefPubMed

11.

Baghdadi YM, Larson AN, Sierra RJ (2013) Restoration of the hip center during THA performed for protrusio acetabuli is associated with better implant survival. Clin Orthop Relat Res 471(10):3251–3259. doi:10.1007/s11999-013-3072-x PubMedCentralCrossRefPubMed

12.

Ahmed E, Ibrahim el-G, Ayman B (2015) Total hip arthroplasty with subtrochanteric osteotomy in neglected dysplastic hip. Int Orthop 39(1):27–33. doi:10.1007/s00264-014-2554-0 CrossRefPubMed

13.

Zahar A, Papik K, Lakatos J, Cross MB (2014) Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up. Int Orthop 38(5):947–951. doi:10.1007/s00264-014-2280-7 PubMedCentralCrossRefPubMed

14.

Murayama T, Ohnishi H, Mori T, Okazaki Y, Sujita K, Sakai A (2014) A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. Int Orthop. doi:10.1007/s00264-014-2613-6 PubMed

15.

de Campos JP, Schwartsmann CR, Faria M, Bernabé AC, Gomes M, de Luca GJ (2009) Otto pelvis remodeling after total hip arthroplasty. Acta Ortop Bras 1(17):58–61

16.

Grobler GB, Dower BJ, Nortje MB, Walters J (2012) The results of a cementless acetabular component combined with impaction bone grafting in patients with acetabular protrusion. SA Orthop J 11(3):29–33

17.

Baird EO, Kang QK (2009) Prophylaxis of heterotopic ossification - an updated review. J Orthop Surg Res 4:12. doi:10.1186/1749-799X-4-12 PubMedCentralCrossRefPubMed

18.

Neal BC, Rodgers A, Clark T, Gray H, Reid IR, Dunn L, MacMahon SW (2000) A systematic survey of 13 randomized trials of non-steroidal anti-inflammatory drugs for the prevention of heterotopic bone formation after major hip surgery. Acta Orthop Scand 71(2):122–128. doi:10.1080/000164700317413076 CrossRefPubMed

19.

Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z (2011) Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials. Int Orthop 35(1):3–8. doi:10.1007/s00264-009-0886-y PubMedCentralCrossRefPubMed

Title: Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion
Authors: Sándor-György Zuh
Ancuţa Zazgyva
István Gergely
Tudor Sorin Pop
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2804-9

At a glance: The STEP trials

Springer Medicine

Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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