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Hemispherical hydroxyapatite-coated cups for acetabular revision in severe bone defects: 3 to 7 year results

I. Escriba, R. Sancho, X. Crusi, M. Valera

Category: Furlong Clinical Results

Orthopaedic and Traumatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Aims: The purpose of this study is to evaluate clinic and radiological results in acetabular revision using hemispherical hydroxyapatite (HA)-coated cups and morselized allograft in the presence of severe bone defects (Paprosky type III A).

Methods: From a series of 218 patients having revision total hip arthroplasty between1995 and 1999, 42 hips in 42 patients were included in this retrospective study. The inclusion criteria were:
1. – Presence of severe bone loss without pelvic discontinuity (Paprosky type III A).
2. – Use of hemispherical HA-coated acetabular component inserted without cement.
3. – Aseptic loosening as cause of revision. All revisions were carried out by the same surgical team using a postero-lateral approach. Morselized allograft was used in all cases. The mean age at the time of revision surgery was 70 years (range, 48 to 84). The mean follow-up was 52 months (range, 36 to 81). In 39% of the cases a extra large cup (more than 60 mm) was used.

Results: the average Merle d’Aubigné score rose from 7.3 points preoperatively to 17.2 points at follow-up (90% of the patients were pain free). All the cups remained radiologically stable at follow-up. Partial resorption of the allograft without jeopardising implant stability was detected in 4 cases (10%); all the rest showed radiological consolidation and remodelling of the medial wall of the acetabulum.

Conclusions: these results strongly support the use of hemispherical HA-coated cups, combined with morselized allograft, in acetabular revision even in the presence of major acetabulum bone loss.

Paper presented at EFORT 2003, Helsinki, Finland, June 4 – 10 2003.