EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES

A.E. Gross

doi:10.1302/1358-992X.98BSUPP_22.CCJR2015-063

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General Orthopaedics

EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES

Current Concepts in Joint Replacement (CCJR) – Winter 2015 meeting (9–12 December).

A.E. Gross

EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES

Gross A. EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES. Orthop Procs. 2016;98-B(SUPP_22):63-63. doi:10.1302/1358-992X.98BSUPP_22.CCJR2015-063

Gross, A.E.. “EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES.” Orthopaedic Proceedings, vol. 98-B, no. SUPP_22, 2016, pp. 63-63., https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-063

Gross, A. (2016). EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES. Orthopaedic Proceedings, 98-B(SUPP_22), 63-63. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-063

Gross, A. (2016) “EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES.” Orthopaedic Proceedings, 98-B(SUPP_22), pp. 63-63. Available at: https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-063

Gross, A.E. “EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES.” Orthopaedic Proceedings 98-B, no. SUPP_22 (2016): 63-63. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-063

Gross A. EXTENSIVE ACETABULAR BONE LOSS: IMPACTION GRAFTING, A PREFERRED SOLUTION – OPPOSES. Orthop Procs. 2016 Dec 1;98-B(SUPP_22):63-63. https://doi.org/10.1302/1358-992X.98BSUPP_22.CCJR2015-063

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Abstract

Impaction grafting is an excellent option for acetabular revision. It is technique specific and very popular in England and the Netherlands and to some degree in other European centers. The long term published results are excellent. It is, however, technique dependent and the best results are for contained cavitary defects. If the defect is segmental and can be contained by a single mesh and impaction grafting, the results are still quite good. If, however, there is a larger segmental defect of greater than 50% of the acetabulum or a pelvic discontinuity, other options should be considered.

Segmental defects of 25–50% can be managed by minor column (shelf) or figure of 7 structural allografts with good long term results. Porous metal augments are now a good option with promising early to mid-term results. Segmental defects of greater than 50% require a structural graft or porous augment usually protected by a cage. If there is an associated pelvic discontinuity then a cup cage is a better solution.

An important question is does impaction grafting facilitate rerevision surgery? There is no evidence to support this but some histological studies of impacted allograft would suggest that it may. On the other hand there are papers that show that structural allografts do restore bone stock for further revision surgery. Also the results of impaction grafting are best in the hands of surgeons comfortable with using cement on the acetabular side, and one of the reasons why this technique is not as popular in North America.