B. Hintermann et Ew. Morscher, TOTAL HIP-REPLACEMENT WITH SOLID AUTOLOGOUS FEMORAL-HEAD GRAFT FOR HIP-DYSPLASIA, Archives of orthopaedic and trauma surgery, 114(3), 1995, pp. 137-144
Acetabuloplasty with solid autologous femoral head graft for the treat
ment of hip dysplasia is an established method which creates the conta
ined cavity needed to accommodate the artificial cup. In order to eval
uate the medium- and long-term results of this method using a cementle
ss hemispheric cup, 34 patients (39 hips) operated on between 1979 and
1986 were clinically and radiologically reviewed. The minimal follow-
up was 5 years (average 7.6 years). The Harris hip score increased fro
m 36 points preoperatively to 89 points 1 year postoperatively and to
85.1 at the last follow-up. On roentgenographic evaluation, all grafts
had been incorporated and appeared to have tolerated the mechanical l
oading well. Partial resorption of the graft occurred in 22 of the 39
hips, mainly in the lateral non-loaded zone. Twenty-nine of the 39 ace
tabular components showed migration, on average 4.2 mm cranially and 1
.8 mm medially; 92% occurred during the first 2 years, and thereafter
it was not progressive. Smaller cups migrated consistently more than l
arger cups. A significant correlation was found between cup migration
and the degree of bone coverage of the cup, and extensive migration oc
curred in most cases with cup coverage by the host bone of less than 4
0%-50% of the weight-bearing surface of the cup. Only one acetabular c
omponent was altered significantly, and another appears to have become
loose. The use of normal-sized cups and cementless fixation medially
in the primary acetabulum are thought to have contributed to our favor
able mid- to long-term results. The substantial migration rate during
the first 2 years was not related to loosening, and it did not continu
e to progress. Apparently, some migration must be accepted, and this d
oes not necessarily correspond to cup loosening.