Nine-year results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacement

• Published in: Annals of the Royal College of Surgeons of England Vol. 99; no. 3; pp. 203 - 206
• Main Authors: Drampalos, E, Fadulelmola, A, Mohammed, R, Shaw, D, Subramanian, S, Jain, K D, Hodgkinson, J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2017; Royal College of Surgeons
• Subjects: Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - methods; Bone Transplantation - methods; Cartilage - transplantation; Cartilage, Articular - surgery; Female; Femur Head - transplantation; Follow-Up Studies; Hip joint; Hip Joint - surgery; Hip Surgery; Humans; Joint surgery; Kaplan-Meier Estimate; Male; Middle Aged; Prosthesis Failure; Reoperation; Retrospective Studies; Revisions; Skin & tissue grafts; Transplantation, Homologous; Treatment Outcome; United Kingdom > UK; Articular cartilage; Femoral head; Allograft; Hip replacement; Acetabular impaction
• DOI: 10.1308/rcsann.2016.0316
• ISSN: 0035-8843

INTRODUCTION Acetabular impaction bone grafting with a cemented polyethylene socket aims to reconstitute the bone stock in hip revision. This is an effective but resource intensive and time consuming technique. Usually, the articular cartilage is removed from the femoral head allograft. Our objective was to assess the late results of using the whole femoral head, retaining the cartilage. METHODS Forty-two acetabular revisions using impacted morselised bone graft (retaining the articular cartilage) and a cemented socket were studied retrospectively. The mean follow-up duration was 9.3 years (range: 6-13 years). Clinical and radiological assessment was made using the Oxford hip score, the classification of Hodgkinson et al (1988) for socket loosening and the classification of Gie et al (1993) for evaluation of allograft incorporation. RESULTS Twenty-seven sockets (75.0%) were radiologically stable, six (16.7%) were radiologically loose and three (8.3%) had migrated. Thirty cases (83.3%) showed good trabecular remodelling and six (16.74%) showed trabecular incorporation without remodelling. Six patients were lost to follow-up. Kaplan-Meier analysis calculated a survival rate of 94.5% at a mean of 9.3 years (95% confidence interval: 8.1-10.4 years) for all reasons of failure, with two re-revisions. CONCLUSIONS The nine-year results of the aforementioned technique are comparable with other major studies. Particularly when the supply of allograft and operative time are limited, retaining the articular cartilage of the femoral head is a safe and successful alternative.