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KMID : 0386720050170010001
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Journal of the Korean Hip Society
2005 Volume.17 No. 1 p.1 ~ p.7
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Isolated Acetabular Revision Hip Arthroplasty Using Cementless Cup and Bone Graft
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Choi Il-Yong
Kim Young-Ho
Roh Won-Il
Cho Young-A
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Abstract
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Purpose: Surgeon occasionally meet the situation, in which the loose acetabular component is the main cause of revision hip arthroplasty without loosening of the femoral stem. The purpose of our study is to assess the clinical and radiological results for isolated acetabular revision.
Materials and Methods: Twenty seven isolated acetabular revision hip arthroplasties performed between October 1991 and April 2000 have been reviewed during 3 years 3 months to 11 years 11 months. The average period of follow-up was 7 years 6 months. The mean age of the patients at the time of the operation was 48.9 years old. The implants used before the revision included 18 Trilock, 2 Omnifit and 7 for the others. The implants used in revision are 19 Omnift and 8 AML. The main causes for revision are followings; the loosenings of acetabular cup had 9 cases, the osteolyses with wear of polyethylene insert had 15 cases and the protrusion of bipolar cups had 3 cases. In all cases of our series the trochanteric osteotomy was performed and the cementless cup was used with bone graft in acetabular cup fixed with screws.
Results: The mean Harris hip scores were improved from 61 to 86. All the stems retained during revision arthroplasty had remained well-osseointegrated with endosteal spot weld. The 5 stress shieldings and 10 calcar rounding were observed but there were no circumferential radiolucent lines and subsidence. The 20 cases of bone grafts were incorporated between 3 and 6 months after revision and within 12 months for the other cases. There was no migration more than 4 mm and there were 3 cases in which the change of angle of the cup was occurred more than 5 degrees. The re-revisions were performed in 3 cases; the loosenings of acetabular component were the main cause in 2 cases and the osteolysis in 1 case. 2 cases of dislocation were occurred but there was no infection, nerve injury and fracture.
Conclusion: All the retained femoral stems during isolated acetabular revision had remained successfully without loosening. And the bone grafts in acetabulum were well-incorporated at last follow-up. The retention of well-fixed femoral stem is recommendable if there is confidence of stability for the femoral stem.
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