The survival and fate of acetabular reconstruction with impaction grafting for large defects.

Abstract

Impaction bone grafting has been used for acetabular reconstruction in revision surgery. However, most series do not establish differences in survival in revisions with differing severity of bone loss. We therefore determined (1) the survival rate for rerevision associated with varying degrees of bone loss; (2) the frequency with which bone graft resorption occurred; and (3) whether the reconstruction restored the anatomic center of rotation of the hip. We retrospectively reviewed 165 patients (181 hips) who underwent rerevision for major bone loss. Using the classification of Paprosky et al. 98 hips had a Grade 3A defect and 83 a Grade 3B. We determined survival rates for revision and graft resorption. Cup position was determined measuring vertical and horizontal positions and the distance from the center of the prosthetic femoral head to the normal center of rotation of the hip in both groups according to Ranawat. The minimum followup until rerevision or the latest evaluation was 0.3 years months (mean, 7.5 years; range, 0.3-17.7 years). The survival rate for revision at 8 years was 84% (95% confidence interval: 61-100) for Grade 3A and 82% (95% confidence interval: 68-100) for Grade 3B. Twelve hips were rerevised. Seventeen grafts showed bone resorption. Acetabular cup position was anatomically restored in both Grades 3A and 3B. The midterm results for impacted bone allograft and cemented all-polyethylene cups were similar in both Grade 3A and Grade 3B hips. Acetabular reconstruction allows anatomic positioning of the cups and is associated with a low rate of rerevision.