Acetabular reconstruction with bone impaction grafting and a cemented cup - 20 years' experience

Acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. In 1979, a biologic method was introduced with tigh tly impacted cancellous allografts in combination with a cemented polyethyl ene cup for acetabular reconstruction. With this technique, it is possible to replace the loss of bone and to repair normal hip mechanics and hip func tion with a standard implant. Based on the authors' 20 years experience, a review of the long-term data is presented in primary total hip arthroplasty with preexisting acetabular bone stock loss, primary total hip arthroplast y in rheumatoid arthritis, patients who had bone impaction when younger tha n 50 years, and in acetabular revisions. The survival rate with revision of the cup for aseptic loosening as the end point was 94% at 10 to 17 years, 90% at 10 to 18 years, 91% at 10 to 17 years, and 92% at 10 to 15 years. Fr om biopsy specimens from humans and histologic data in animal experiments t he incorporation of these impacted bone chips was proven. The acetabular bo ne impaction technique using large morselized bone chips (range, 0.7-1 cm) and a cemented cup is a reliable technique with favorable long-term outcome .