HIGH FAILURE RATE OF BULK FEMORAL-HEAD ALLOGRAFTS IN TOTAL HIP ACETABULAR RECONSTRUCTIONS AT 10 YEARS

The authors evaluated the radiographic appearance and functional perfo rmance of 30 cemented total hip arthroplasty acetabular reconstruction s in 28 patients in whom bulk, weight-bearing, femoral head allografts were used to augment severe acetabular bone deficiency with a mean fo llow-up period of 10 years (range, 8-13.3 years). The average age of t he patients was 51 years. The current study group represents the 10-ye ar subset of a larger series of 38 hip reconstructions previously repo rted. The graft was bolted within the acetabulum in 12 hips and to the lateral wing of the ilium in the other 18 hips. On average, these gra fts supported approximately 60% of the acetabular component. All graft s united. Failure of fixation of the acetabular component occurred in 47% of the acetabular reconstructions (14 hips in 14 patients). Four w ere diagnosed as loose on the basis of radiographic criteria alone and the other 10 hips had a loose acetabular component at reoperation. Lo osening occurred in 58% (7 of 12) of the sockets with intraacetabular graft and in 40% (7 of 18) of those bolted to the lateral ilium. The f ailure rate of 47% in these reconstructions at 10 years-is in sharp co ntrast to high success rates at less than 5 years and argues against t he use of bulk weight-bearing allografts for most situations unless th e only alternative is resection arthroplasty.