Revision With Impacted Bone Allografts and the Kerboull Cross Plate for Massive Bone Defect of the Acetabulum
Section snippets
Materials and Methods
Between 1997 and 2004, we retrospectively reviewed 34 patients (34 hips) with massive bone defect due to aseptic loosening of the acetabulum treated with an impacted bone allograft using the Kerboull-type acetabular device (Kobe Steel, Kobe, Japan). We ascertained the relationship between follow-up results and the thickness of the bone graft using postoperative radiography.
One patient was excluded from the study group because components were removed because of infection 1 month postoperatively.
Results
Seven hips showed radiological failure, and the remaining 24 hips were stable on follow-up radiographs. Mean thickness of the bone graft was 20.9 mm (range, 10-53 mm). Six hips (19%) developed fracture of the device and/or the screw. In 1 patient (3%), the device fractured; in 3 patients (10%), the screws fractured; and in 2 patients (7%), both the device and the screws fractured. Mean period from revision surgery to fracture of the screw or device was 23.7 months (6-24 months). At final
Complications
Postoperative dislocation occurred in 2 cases, but further dislocation did not occur after the patients wore a hip brace for 3 months. One patient developed transient irritation of the sciatic nerve. Deep thrombosis of the femoral vein occurred in 1 patient. Deep infection occurred in 1 patient treated with removal of the acetabular and femoral components.
Discussion
High failure rate of revision using the Kerboull acetabular reinforcement device with the morselized bone graft was observed in the hip with large bone defect of the acetabulum before surgery.
Our study had certain limitations. First, the thickness of the bone graft was addressed as a 2-dimensional aspect on radiographs despite the 3-dimensional structure of the bone graft. Second, HA granules were also used in 15 of the 31 hips in addition to the morselized allograft, and 3 of the 7 hips with
Acknowledgments
The authors thank Dr Kenji Yamada, Dr Katsuro Takahashi, Dr Hirokazu Iida, and Dr Takahiko Wada for assistance and advice concerning revision total hip arthroplasty using the Kerboull cross plate.
References (24)
- et al.
Acetabular components without bulk bone graft in revision surgery: a 5- to 13-year follow-up study
J Arthroplasty
(2003) - et al.
A quantitative in vitro assessment of fit and screw fixation on the stability of a cementless hemispherical acetabular component
J Arthroplasty
(1994) - et al.
The management of severe acetabular bone loss using structural allograft and acetabular reinforcement devices
J Arthroplasty
(2000) - et al.
Acetabular reconstruction using a Kerboull-type acetabular reinforcement device and hydroxyapatite granules: a 3- to 8-year follow-up study
J Arthroplasty
(2003) - et al.
Acetabular reconstruction with morcellized allograft and ring support: a medium-term review
J Arthroplasty
(1999) - et al.
Revision of aseptic loose total hip arthroplasties
Clin Orthop Relat Res
(1982) - et al.
Revision total hip arthroplasty
J Bone Joint Surg Am
(1985) - et al.
Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis
J Bone Joint Surg Am
(1992) - et al.
Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2- to 13-year follow-up study of 142 aseptic revisions
J Bone Joint Surg Br
(2006) - et al.
Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts
J Bone Joint Surg Br
(1990)
Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years
J Bone Joint Surg Br
Impaction allografting and the Kerboull acetabular reinforcement device: 35 hips followed for 3-7 years
Acta Orthop
Cited by (42)
Influence of dual mobility acetabular implant on survival of revision cup and Kerboull reinforcement ring in aseptic acetabular loosening
2022, Revue de Chirurgie Orthopedique et TraumatologiqueInfluence of dual-mobility acetabular implants on revision and survivorship of cup and Kerboull-type reinforcement ring constructs in aseptic acetabular loosening
2022, Orthopaedics and Traumatology: Surgery and ResearchUse of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years’ average follow-up
2019, Revue de Chirurgie Orthopedique et TraumatologiqueUse of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years’ average follow-up
2019, Orthopaedics and Traumatology: Surgery and ResearchAcetabular Revision using Trabecular Metal Augments for Paprosky Type 3 Defects
2018, Journal of Arthroplasty
No benefits or funds were received in support of the study.