Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip - Results at five to twelve years

Background: Anterolateral acetabular bone deficiency is one of the technica l problems associated with total hip arthroplasty in patients with developm ental hip dysplasia. The purpose of this study was to evaluate the results of one method of acetabular reconstruction for hip dysplasia-placement of a n uncemented socket in conjunction with a bulk femoral head autograft. Methods: Forty-four hips in thirty-five patients (twenty-nine female and si x male; average age, thirty-nine years) with developmental hip dysplasia we re treated with primary total hip arthroplasty with use of an uncemented po rous-coated titanium cup fixed with screws and an autogenous bulk femoral h ead graft. The patients were followed clinically in a prospective fashion f or five to 12.3 years (mean, 7.5 years), and radiographs were analyzed retr ospectively. Results: Four acetabular components were revised: two, because of severe po lyethylene wear and osteolysis; one, because of aseptic loosening; and one, because of fracture of the acetabular shell. The mean Harris hip score for the unrevised hips improved from 51 points preoperatively to 91 points pos toperatively. No unrevised socket had definite radiographic evidence of loo sening. Forty-three of the forty-four hips had no radiographic evidence of resorption of the graft or had radiographic evidence of resorption limited to the nonstressed area of the graft lateral to the edge of the cup. Conclusions: This method of reconstruction provided reliable acetabular fix ation and appeared to restore acetabular bone stock in patients with develo pmental hip dysplasia. We use this technique for patients with moderate ant erolateral acetabular bone deficiency requiring total hip arthroplasty.