Background: Acetabular bone deficiency can present a challenge
during total hip arthroplasty, especially in young patients. The purpose of
the present study was to evaluate the long-term clinical and radiographic
outcomes of primary and revision acetabular reconstruction with use of an
impaction bone-grafting technique and a cemented polyethylene cup in young
patients who had preexisting acetabular bone deficiency.
Methods: Forty-two consecutive acetabular reconstructions were
performed in thirty-seven patients who were younger than fifty years old
(average, 37.2 years old). The impaction bone-grafting technique was used for
twenty-three primary and nineteen revision acetabular reconstructions.
Twenty-eight patients (thirty-one hips) were available for review after a
minimum duration of follow-up of fifteen years. Clinical and radiographic
results were assessed, and survivorship analysis was performed with the
Results: Eight hips were revised at a mean of twelve years (range,
three to twenty-one years) after a primary reconstruction (four hips) or
revision reconstruction (four hips). The revision was performed because of
aseptic loosening of the acetabular component in four hips and because of
culture-proven septic loosening in two. Two additional cups (both in hips that
had had a revision reconstruction) were revised, during revision of the
femoral stem, because of wear (one hip) or because of persistent
intraoperative instability (one hip). Twenty-eight hips (in twenty-five
patients) had retention of the acetabular component for a minimum of fifteen
years. The mean Harris hip score for that group was 89 points. Twenty-six of
these twenty-eight hips had no or slight pain. Kaplan-Meier analysis revealed
a twenty-year survival rate of 80% (95% confidence interval, 67% to 94%) with
acetabular revision for any reason as the end point and of 91% (95% confidence
interval, 80% to 100%) with acetabular revision because of aseptic loosening
as the end point.
Conclusions: Acetabular reconstruction with use of impaction
bone-grafting and a cemented polyethylene cup is a reliable and durable
technique that is associated with good long-term results in young patients
with acetabular bone-stock defects.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.