TOTAL HIP-REPLACEMENT WITH BONE-GRAFTING USING THE REMOVED FEMORAL-HEAD IN SEVERE ACETABULAR DYSPLASIA

We carried out total hip replacement and femoral head bone-grafting in 21 hips with congenital dysplasia or dislocation, obtaining as much s upport of the cup by the host bone as was possible. A Charnley small o r extra small cup was implanted in 20 cases and a miniature femoral co mponent in 15. The results of 20 hips were reviewed prospectively at a n average of 10 years. Nineteen patients had no pain. Three cups showe d radiological signs of loosening, one was causing other symptoms. All the sterns, except one, were radiologically stable and were symptomle ss. The graft had fused without resorption in 18 cases. Two grafts sho wed severe resorption with loosening of the cup. Satisfactory long ter m results of total hip replacement and femoral head bone-grafting can be achieved using special surgical techniques and the appropriate comp onents. Medialisation of the hip and the use of small cups are importa nt in allowing sufficient support of the prosthesis by bone so that th e distribution of load on the graft is minimised. The grafted femoral head provides suitable bone stock for reconstruction of the acetabulum .