Abstract
Introduction The results of THA in patients with post-traumatic arthritis are inferior to those in nontraumatic arthritis, both after cemented and noncemented THA. This increased failure rate is caused by the bone stock loss and the abnormal anatomy. We studied the outcome of acetabular bone impaction grafting and a cemented cup in 20 cases at 3 to 18 years follow-up.
Materials and Methods Between January 1984 and January 2000 in 20 consecutive patients bone impaction grafting was used for arthritis after previous acetabular fracture, grafting was done in all for bone stock loss. There were 14 men and 6 women. The average age at THA was 53.3 years (range, 35 to 75 years). Defects were classified according to the AAOS acetabular defect classification (3 type I defects, 10 type II defects, 5 type III defects and 2 type V). Metal meshes were used in 6 medial wall and in 3 peripheral wall defects. In 15 cases autograft bone chips were used, in 5 both auto- and allograft was used. Grafts were impacted using impactors and a hammer and a PE cup was cemented. At review in January 2003 no patient was lost.
Results Two patients died during follow up after 3 and 4 years respectively, deaths were not related to surgery and data are included. The mean follow up was 9.5 years (range, 3 to 18 years). The pre-operative Harris hip score was 44 (32–61). During follow up a cup revision was performed in two cases; one for a culture proven septic loosening 14.5 years after surgery and the other for aseptic loosening at 15.3 years after surgery. Both revised cups were radiologically loose at revision. At review the 16 surviving hips had an aver. Harris hip score of 93 points (range, 62 to 100 points). Fourteen hips were free of pain, one patient had slight and one had mild pain.
Radiologically, none of these 16 cups was loose. However, two of the cups migrated more than 5 mm (e.g. 6 and 8 mm) relative to the initial post-operative X-ray. At review, both patients were symptom free.
The Kaplan-Meier survival rate of the cup with endpoint revision for any reason was 100% at ten years and 80% (95% CI, 62–98%) after 15 years; with endpoint cup revision for aseptic loosening the survival was 100% both at 10 and 15 years.
Conclusion The acetabular bone impaction grafting technique with a cemented cup is a biologically attractive technique to reconstruct the bone stock loss after posttraumatic arthritis with good long-term survival, even after long follow-up.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
