Impaction grafting and acetabular reinforcement in revision hip replacement

Summary.

A substantial loss of bone stock is frequently encountered at revision of a hip replacement. A mix of autologous and homologous bone chips is a biological method of filling the cavities. Reinforcement implants can be used to anchor the new prosthesis and to impact the bone graft, protecting it during healing. The goals of this study were to evaluate the clinical and radiological results after revision of cups with aseptic loosening. Follow-up examination of 81 revisions in 78 patients at 6.5 years (range 3 to 9 years) showed that 93% of the patients were satisfied with their results. One patient underwent a further revision because of recurrent dislocation of the femoral head, and one had a superficial infection. All the grafts were fused at 3 months after the operation. The bone stock had increased in every case, but 6 of them show some degree of graft resorption. No implant showed impending signs of loosening. These results were encouraging. The reinforcement implants allow sufficient primary fixation and secondary stability can be achieved with the impaction grafting. Careful preoperative evaluation and assessment at operation is important to match bone defects with the grafts and selection of the prosthesis.

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