BONE-GRAFTING IN TOTAL HIP-ARTHROPLASTY FOR INSUFFICIENT ACETABULUM

We assessed the effectiveness of total hip arthroplasty (THA) suppleme nted with autologous bone grafts in patients with congenital disease o f the hip (CDH). 2 groups of patients were evaluated: In Group A, 33 p atients with a mean age of 54 years underwent arthroplasties using a t hreaded ceramic conical acetabular cup without cement (Autophor). In G roup B, 85 patients with a mean age of 55 years underwent arthroplasti es using a threaded, noncemented, titanium cup (CST). Bone grafts were supplemented the THA in 3 ways: 1) intrapelvic application using the cotyloplasty technique, 2) as bone chips in order to cover small defec ts around the upper and lateral part of the cup, and 3) as a bulky cor ticocancellous graft which was secured with screws. Follow-up averaged 11 and 9 years for patients in Groups A and B, respectively. All the grafts in Group A had consolidated by the end of 6th month. On ly 2 pa rtial absorptions were observed, 1 intrapelvic graft and 1 corticocanc ellous graft. 2 revisions were performed in this group of patients, bu t neither were related to bone graft absorption. By the end of 6 month , 63 of 85 in Group B had consolidated bone grafts. In 16 patients wit h intrapelvic cotyloplasty, 3 demonstrated complete and 1 partial abso rption of the grafts. 3 cup revisions were performed in this group of patients, all with complete graft absorption. Our findings indicate th at autologous bone grafts are strong adjunct for satisfactory fixation of THA in patients with CDH, a particularly demanding group of patien ts to manage. In addition, the ceramic threaded cup was found to be su perior to the titanium threaded cup in terms of both bone graft consol idation and the number of revisions required.