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Cementless Acetabular Reconstruction and Structural Bone-Grafting in Dysplastic Hips
C. Hendrich, MD1; I. Mehling, MD2; U. Sauer, MD3; S. Kirschner, MD4; J.M. Martell, MD5
1 Orthopädisches Krankenhaus Schloss Werneck, Balthasar-Neumann-Platz 1, 97440 Werneck, Germany. E-mail address for C. Hendrich: christian.hendrich@kh-schloss-werneck.de
2 Department of Trauma Surgery, Johannes-Gutenberg-University, Langenbeckstrasse 1, 55101 Mainz, Germany
3 Department of Surgery, Würzburg University, Oberdürrbacher-Strasse 6, 97080 Würzburg, Germany
4 Department of Orthopedics, Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
5 Department of Surgery, Section of Orthopaedics, University of Chicago Medical Center, MC 3079, 5841 South Maryland Avenue, Chicago, IL 60637
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedics, Würzburg University, Würzburg, Germany

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Feb 01;88(2):387-394. doi: 10.2106/JBJS.D.02373
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Background: Studies of acetabular reconstruction with use of cement and bulk bone graft have demonstrated increasing rates of cup failure in patients with dysplastic hips seven years after total hip arthroplasty. Comparable data on the long-term results of bulk bone-grafting done in conjunction with cementless implants are limited. The aim of this study was to review the clinical and radiographic results of autologous bulk bone-grafting in conjunction with a cementless cup.

Methods: From 1987 to 1992, forty-seven patients (forty women and seven men, with an average age of 50.4 years) who had developmental dysplasia of the hip underwent fifty-six total hip arthroplasties and received a structural graft in combination with a cementless Harris-Galante type-I cup. All patients were followed prospectively. In fifty-five hips, implant migration was measured with single-image radiographic analysis.

Results: After an average duration (and standard deviation) of 10.2 ± 2.9 years, three patients (four hips) had died. In the surviving patients, four implants had been revised and two had radiographic evidence of loosening. With use of revision and loosening as end points, the eleven-year survival rates were 91.6% and 88.9%, respectively. Of the fifty implants that had no loosening, fourteen had measurable cup migration, thirty-five had no migration, and one implant could not be measured. All migrations but one were progressive. With loosening used as the end point, the survival rate at eleven years was 100% for the implants with no migration; however, the survival rate for the cups that had migrated was 69.3% (p = 0.0012).

Conclusions: The eleven-year survival rate for the spherical press-fit cups in combination with bulk bone-grafting is satisfactory, given the complexity of these reconstructions. However, the difference between the survival of the implants that had migrated and those that had not was significant. We expect that the thirteen implants with progressive acetabular migration at the time of the latest follow-up are at risk for loosening, which will increase the revision rate for this series in the coming years.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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