Osseointegration and Success in Hip Arthroplasty Acetabular Revision Using Structured Homologous Graft: Average 9.6 Years Follow-up

Roos, Bruno Dutra; Roos, Milton Valdomiro; Camisa Júnior, Antero; Lima, Ezequiel Moreno Ungaretti; Betto, Maurício Domingos; Dubiela, Rafaela Scuzziato

doi:10.1055/s-0043-1768619

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Brasil

Revista Brasileira de Ortopedia

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Sumário

Original Study • Rev Bras Ortop 58 (3) • May-Jun 2023 • https://doi.org/10.1055/s-0043-1768619 copy

Osseointegration and Success in Hip Arthroplasty Acetabular Revision Using Structured Homologous Graft: Average 9.6 Years Follow-up

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting.

Methods

A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve.

Results

Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration.

Conclusion

We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.

arthroplasty, replacement, hip; grafting bone; cross-sectional studies; osseointegration; transplantation, homologous, reoperation; osteointegration

	Preoperative				Immediate postoperative		Late postoperative period
#	Gender	Operated side	Age (Years)	ATK type	Date of surgery	Type of revision	Last follow-up (years + months)	Failure
1	Female	Left	40	Cemented	31/01/2007	Cemented	11y + 11m	No
2	Female	Right	46	Hybrid	12/05/2003	Cemented	8y + 4m	No
3	Female	Right	42	Girdlestone	13/11/2002	Cemented	14y + 11m	No
4	Male	Right	43	Cemented	21/02/2003	Cemented	9y + 1m	No
5	Female	Left	77	Cemented	16/07/2001	Cemented	4y + 2m	No
6	Female	Right	47	Not cemented	08/11/2006	Cemented	10y + 10m	No
7	Male	Right	67	Cemented	05/08/2002	Cemented	14y + 6m	No
8	Female	Right	72	Not cemented	17/09/2003	Reverse hybrid	11y+10m	Yes
9a	Female	Right	64	Spacer	19/09/2005	Cemented	7y + 6m	Yes
10a	Female	Right	72	Cemented	13/05/2013	Cemented	7y + 10m	Yes
11	Female	Right	76	Partial	04/02/1997	Cemented	8y	No
12	Female	Left	57	Not cemented	20/11/2000	Cemented	15y + 4m	No
13	Male	Right	67	Cemented	02/08/2004	Cemented	6y + 1m	No
14	Female	Right	71	Cemented	07/11/2005	Cemented	4y + 9m	No
15b	Male	Right	42	Cemented	17/03/1998	Cemented	16y + 10m	No
16b	Male	Left	51	Cemented	14/05/2007	Cemented	7y + 8m	No
17	Male	Right	69	Not cemented	10/05/2001	Cemented	4y + 4m	No
18	Female	Right	78	Cemented	31/01/1995	Cemented	18y + 9m	No
19	Male	Right	72	Cemented	17/01/2008	Cemented	10y + 11m	Yes
20	Female	Right	43	Not cemented	24/06/2003	Cemented	14y + 2m	No
21	Male	Left	47	Cemented	19/11/1996	Cemented	16y + 7m	No
22	Female	Left	57	Not cemented	13/09/2000	Cemented	14y + 1m	Yes
23	Male	Left	59	Cemented	13/04/1999	Cemented	8y + 10m	No
24	Female	Right	72	Cemented	22/11/2006	Cemented	7y + 7m	No
25	Female	Left	65	Not cemented	06/09/2004	Cemented	4y + 0m	No
26	Female	Left	38	Not cemented	14/03/2003	Cemented	15y + 0m	No
27	Female	Left	62	Not cemented	19/05/2005	Cemented	13y + 8m	No
28c	Female	Right	38	Cemented	27/10/2005	Cemented	2y + 1m	Yes
29c	Female	Right	45	Cemented	30/07/2012	Cemented	7y + 2m	Yes
30	Male	Right	77	Cemented	25/10/2002	Cemented	6y + 6m	No
31	Female	Right	73	Not cemented	05/12/2007	Cemented	10y + 6m	No
32	Female	Left	61	Not cemented	21/12/1998	Cemented	12y + 3m	No
33	Female	Left	66	Cemented	25/10/2005	Cemented	13y + 5m	No
34	Female	Left	56	Not cemented	13/10/2004	Cemented	12y + 9m	No
35	Female	Left	41	Not cemented	03/07/2000	Cemented	16y + 3m	No
36	Female	Right	70	Cemented	19/06/2007	Cemented	12y + 5m	No
37d	Male	Left	56	Cemented	27/09/1997	Cemented	6y + 10m	Yes
38d	Male	Left	63	Cemented	27/08/2004	Cemented	15y + 9m	No
39	Female	Right	70	Not cemented	10/08/2015	Reverse hybrid	3y + 2m	No
40	Female	Right	46	Not cemented	15/07/2015	Reverse hybrid	4y + 0m	No
41	Female	Right	63	Cemented	21/07/2015	Reverse hybrid	3a + 1m	Yes
42	Female	Right	64	Cemented	19/05/2015	Reverse hybrid	2a + 1m	No
43	Male	Right	69	Cemented	12/02/2015	Reverse hybrid	2a + 1m	No
44	Male	Left	59	Girdlestone	01/10/2014	Reverse hybrid	2a + 0m	No

Features		Total (n = 44)	Failure (n = 9)	Success (n = 35)	p-value
Failure in osseointegration		62.48 (± 8.26)	65.67 (± 10.95)	61.66 (± 7.39)	0.226≠
Acetabular defect (Paprosky)	2a	1 (2.3%)	0 (0.0%)	1 (100.0%)	0.239Δ
	2b	1 (2.3%)	1 (100.0%)	0 (0.0%)
	3a	20 (45.5%)	4 (20.0%)	16 (80.0%)
	3b	22 (50.0%)	4 (18.2%)	18 (81.8%)
Acetabular defect (D'Antonio)	I	1 (2.3%)	0 (0.0%)	1 (100.0%)	0.178Δ
	Ii	3 (6.8%)	0 (0.0%)	3 (100.0%)
	Iii	39 (88.6%)	8 (20.5%)	31 (79.5%)
	Iv	1 (2.3%)	1 (100.0%)	0 (0.0%)
Coverage (%)		0.77 (± 0.16)	0.76 (± 0.16)	0.78 (± 0.17)	0.748≠
Increased graft thickness		2.20 (± 0.71)	2.30 (± 0.99)	2.17 (± 0.64)	0.907 ≠
Graft configuration (Prieto)	I(flying buttress)	29 (65.9%)	7 (24.1%)	22 (75.9%)	0.662Δ
	II (dome support)	14 (31.8%)	2 (14.3%)	12 (85.7%)
	III (footing)	1 (2.3%)	0 (0.0%)	1 (100.0%)
Osseointegration (Coon)	1 (total)	27 (61.4%)	3 (11.1%)	24 (88.9%)	≤0.001Δ
	2 (partial)	11 (25%)	0 (0.0%)	11 (100.0%)
	3 (away)	6 (13.6%)	6 (100.0%)	0 (0.0%)
Migration (> 2 mm)		9 (20.5%)	0 (0.0%)	35 (100.0%)	≤.001¥
Absorption (DeLee Zone I)		14 (31.8%)	5 (55.6%)	9 (25.7%)	0.117¥
Osteolysis (DeLee Zone III)		8 (18.2%)	2 (22.2%)	6 (17.1%)	0.659¥
Migration		8 (18.2%)	8 (88.9%)	0 (0.0%)	≤0.001¥
Reoperation		8 (18.2%)	6 (66.7%)	2 (5.7%)	≤0.001¥
Revision		4 (9.1%)	4 (9.1%)	0 (0.0%)	≤0.001¥

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Bruno Dutra Roos, MD, Serviço de Cirurgia do Quadril, Rua Sete de Setembro 817, Hospital Ortopédico de Passo Fundo, Passo Fundo, RS, Brasil. CEP: 99010-121 (e-mail: brunodroos@gmail.com).