AUTOGENOUS BONE-GRAFTS FROM THE FEMORAL-HEAD FOR THE TREATMENT OF ACETABULAR DEFICIENCY IN PRIMARY TOTAL HIP-ARTHROPLASTY WITH CEMENT - LONG-TERM RESULTS

Thirty-five consecutive total hip arthroplasties in twenty-eight patie nts were performed with use of cement and insertion of an autogenous g raft from the femoral head. Five patients (six hips) subsequently died or were lost to follow-up. The results for the remaining twenty-three patients (twenty-nine hips) were reviewed retrospectively at a mean o f eleven years (range, seven to seventeen years) after the operation. All of the grafts united. The mean estimated coverage of the acetabula r component by the autogenous graft was 27 per cent (range, 15 to 45 p er cent). Three sockets (10 per cent) were revised because of symptoma tic loosening without infection at a mean of ten years (eight, ten, an d twelve years) after the index procedure. All three hips were found t o have viable, bleeding bone in the region of the remaining graft. An additional eight acetabular components had a nonprogressive, asymptoma tic, continuous radiolucent line at the cement-bone interface. This fi nding was assumed to indicate loosening of the socket, so the total pr evalence of loosening was 38 per cent (eleven of twenty-nine sockets). There was no significant difference between the loose and the well fi xed components in terms of the amount of coverage by the graft (p > 0. 2) or the method of fixation (p > 0.4). There was no collapse or resor ption of the graft that was of mechanical consequence. Autogenous femo ral-head bone-grafting is a useful technique,vith a good potential for long-term success when the amount of coverage by the graft is limited to less than 40 per cent of the surface of the acetabular component.