Although Impaction grafting proved efficacy in the reconstruction of acetabular defects in primary and revision hip arthroplasty, its role in large segmental defects is still debatable.
Our objective is to determine hip center restoration and last follow up migration after acetabular reconstruction with impaction grafting in different types of acetabular defects
Methods
This is a single-center retrospective radiographic study of (107) total hip arthroplasty (42 primary, and 65 revision) in (104) patients using impaction grafting.
The available radiographs (preoperative, immediate postoperative, and last follow-up) were examined for normal, preoperative, immediate postoperative, and last follow-up vertical (V) and horizontal (H) hip center.
Maximum Acetabular Defect Distance (MADD), presence and size of the mesh were recorded.
Results
In type 1 and 2 AAOS defects, the postoperative hip center was not significantly different from the normal hip center measured on the contralateral healthy side or by Ranawat method.
In Type 3 Defects there was a significant variation between the normal hip center and the postoperative hip center (P-value: 0.034 and 0.001 for V and H respectively). At 44 Months follow up of 36 hips; 31 (86%) hips migrated (range 1-42 mm). The mean amount Migration ± SD was 5.72 ± 3.7, 2, 4.15 ± 1.2, and 11.26 ± 3.9 mm for types 1,2, and 3 respectively (P-value 0.211). Hips with MADD > 15 mm, with mesh, especially large mesh sizes migrate significantly more (p-value = 0.042, 0.037, and 0.039 respectively).
Conclusions
Hip center restoration was better and migration was less for type 1and 2 AAOS rather than for type 3. Other options for reconstruction of these challenging defects should be considered.