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Erschienen in:
01.12.2010 | Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty
Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2010
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Background
Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation.
Questions/purposes
We determined if (1) graft fill; or (2) incorporation (measured as graft–bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures.
Methods
We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1–11 years).
Results
The average defect fill was 30% (range, 0%–81%). The average percent of healing to host bone was 24% (range, 0–66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group.
Conclusions
Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing.
Level of Evidence
Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.