Impaction Bone Grafting with Low Dose Irradiated Freeze‐Dried Allograft Bone for Acetabular Reconstruction

• Published in: Orthopaedic surgery Vol. 14; no. 10; pp. 2519 - 2526
• Main Authors: Li, Hongxing, Tan, Kelvin Guoping, Li, Zhiling, Wu, Xiaoxin, Cai, Guangping, Zhu, Weihong, Huang, Tianlong, Wang, Wanchun, Crawford, Ross, Mao, Xinzhan
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2022; John Wiley & Sons, Inc; Wiley
• Subjects: Acetabular bone defect; Acetabular reconstruction; Biological activity; Cartilage; Clinical; Defects; Disease prevention; Drug dosages; Impaction bone grafting; Joint surgery; Low dose irradiated freeze‐dried allograft bone; Polymethyl methacrylate; Prostheses; Revisions; Skin & tissue grafts; Statistical analysis; Surgical techniques; Titanium; Total hip arthroplasty; United Kingdom > UK; Beijing China; China
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13471

Objective Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium‐term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population. Methods This was a single‐center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze‐dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior–posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow‐up. Independent sample ANOVA test and Pearson chi‐square tests are used for statistical analysis. Results There were 61 hips in 57 patients. The average follow‐up time was 35.59 months (5–77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32–58) preoperatively to 86.98 (range: 78–93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow‐up. Although one cup migrated, no revision, re‐revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow‐up. Conclusions IBG with low‐dose irradiated freeze‐dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA. Impaction bone grafting with a cemented cup utilizing autograft, freeze‐dried irradiated allograft or a mixture of them is a reliable technique for restoring acetabular bone defects in primary and revision total hip arthroplasty in the Chinese population.