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KMID : 0386720050170010058
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Journal of the Korean Hip Society
2005 Volume.17 No. 1 p.58 ~ p.64
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Long Term Results of Cementless Acetabular Cup Revision
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Yoo Myung-Chul
Cho Yoon-Je
Kim Kang Il
Ko Dong-Oh
Chun Sung Wook
Roh Jun-Ha
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Abstract
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Purpose: We analysed the mid-to long-term (minimum 5 years) clinical and radiographic results of revision total hip arthroplasty using oversized cementless acetabular cup with bone graft.
Materials and Methods: We analysed 124 hips in 120 patients who underwent acetabular cup revision total hip arthroplsty with morselized allo or autograft. There were 68 male and 52 female patients with an average age of 51 years old(28 to 72 years old). The average follow up period was 7.7 years(5 to 14 years). The causes of revision were aseptic loosening of acetabular component in 95 hips, severe osteolysis around acetabular componet in 15 hips, polyethylene liner dissociation in 7 hips, and infection sequalae in 7 hips. The acetabular deficiency was type II in 109 hips, type III 15 hips with AAOS classification. All patients received porous-coated cementless acetabular cup (HGII: 90, Trilogy: 34) with screw augmentation. Any bone defects present were packed with morselized bone graft and 6 cases with severe superior and posterior segmental defects were reconstructed with acetabuloplasty using strut allograft. The clinical function of the hip was assessed with use of the Harris hip score, radiological results were evaluated with accessment of preoperative and serial follow-up radiographs. Kaplan-Meyer survivorship analysis was performed with removal of acetabular component as end point.
Results: Average Harris hip score was improved from 54.2 preoperatively to 84.7 postoperatively. Three cups were revised again; 1 for aseptic loosening and 2 for infection. Radiographically, 121 hips showed stable fixation of the acetabular cup and good remodeling of grafted bone. Despite various degrees of osteolysis were seen in 24 cases, no acetabular component had radiographic evidence of loosening or progression of osteolysis at the last follow-up examination. Kaplan-Meier survivor rate with removal of the acetabular component for any reason was 97.6% at 7.7years.
Conclusion: Use of cementless acetabular cup yielded successful midterm outcome in our study. These satisfactory midterm results encourage the use of this approach to this type of deficient acetabulum, packing defects with cancellous bone graft. The midterm results of cementless acetabular revisions with morselized allo or autograft is satisfactory and encouraging the use of this procedure. To have good results of revision surgery using cementless cup, we must know how severe it is in the acetabular bone defect and obtain initial stable cup fixation using oversized cup with press fit and screw.
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KEYWORD
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Cementless cup, Acetabular cup revision
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