期刊
JOURNAL OF ARTHROPLASTY
卷 37, 期 7, 页码 1302-1307出版社
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.arth.2022.02.108
关键词
impaction graft; shelf graft; developmental dysplasia of the hip; arthroplasty; acetabular bone defect
类别
This study assessed the outcomes of using impaction or structural graft to address acetabular deficiency during arthroplasty of dysplastic hips. The results showed that majority of the patients with over 30% defect can be treated with a cementless cup and impaction grafting, with good midterm results. In about 20% of cases, a structural support-like shelf graft is required.
Background: Addressing acetabular deficiency during arthroplasty of dysplastic hips is challenging. We assessed outcomes of a protocol for choosing either impaction or structural graft for this purpose. Methods: This retrospective study included 59 patients (71 hips) with a dysplastic hip and over 30% uncoverage that underwent cementless total hip arthroplasty. Morselized impaction grafting was per -formed for hips where initial stability of the acetabular cup was achieved. In others, a shelf graft was inserted before implantation of the acetabular cup. Outcomes were assessed at a minimum follow-up of 4 years. Results: Fifty-seven (80.3%) hips underwent impaction grafting and 14 (19.7%) received a structural graft. Mean age at surgery was 48.1 +/- 13.5 (18-68) years for impaction and 48.6 +/- 14 (24-70) years for shelf grafts. Mean increase in Harris Hip Score was 51.5 +/- 9.3 and 50 +/- 11.2 for the impaction and structural groups, respectively, at a mean follow-up of 92 (49-136) months (P = .6). Heterotopic ossification occurred in 16 patients in the impaction group vs none in the structural group (P = .004). Radiologically, mean percentages of cup coverage provided by the graft were 47.8 +/- 10.9% and 48.9 +/- 13.3% in the impaction and structural groups, respectively (P = .75). All but one of shelf grafts united to host bone and all impaction grafts incorporated. There was one case of cup loosening in the structural graft group. Conclusion: Most dysplastic acetabula with over 30% defect can be addressed using a cementless cup and impaction grafting, with good results in the midterm. In about 20% of cases, initial press-fit is not attainable and structural support-like shelf graft becomes necessary. Level of evidence: IV. (c) 2022 Elsevier Inc. All rights reserved.
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