title: Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis: three to fourteen-year follow-up.
abstract: BACKGROUND
  Acetabular revision in patients with rheumatoid arthritis is often difficult because of the poor quality and quantity of the acetabular bone stock. The purpose of this study was to evaluate the midterm clinical and radiographic outcomes of acetabular revision with use of an impaction bone-grafting technique and a cemented polyethylene cup.
  
  
  METHODS
  Thirty-five consecutive acetabular revisions were performed with impaction bone-grafting and use of a cemented cup in twenty-eight patients with rheumatoid arthritis. The average age at the revision was fifty-seven years. The minimum duration of follow-up of all reconstructions that were still functioning or that were followed until the time of death was three years (mean, 7.5 years; range, three to fourteen years). No patient was lost to follow-up, but five patients (six hips) died before the time of the review. The acetabular bone defects were classified as cavitary in twelve hips and as combined segmental-cavitary in twenty-three.
  
  
  RESULTS
  The five patients (six hips) who died had been doing well at the time of their latest follow-up. Of the remaining patients, six (six hips) had a repeat revision. The average Harris hip score of the living patients with a surviving implant at the time of follow-up was 82 points, and there was no or only mild pain in twenty-one of the twenty-three hips. Radiographic analysis of all twenty-nine hips that had not been revised showed loosening in one hip and a nonprogressive radiolucent line in one zone in two others. Kaplan-Meier analysis demonstrated a prosthetic survival rate, with aseptic loosening as the end point, of 90% at eight years.
  
  
  CONCLUSIONS
  Acetabular revision with impaction bone-grafting and a cemented cup in patients with rheumatoid arthritis had acceptable results at an average of 7.5 years postoperatively.
authors.affiliation: Department of Orthopaedic Surgery, University Medical Centre Nijmegen, Nijmegen, The Netherlands. b.schreurs@orthop.umcn.nl
authors.forename: B Willem
authors.initials: BW
authors.lastname: Schreurs
authors.forename: Truike M
authors.initials: TM
authors.lastname: Thien
authors.forename: Maarten C
authors.initials: MC
authors.lastname: de Waal Malefijt
authors.forename: Pieter
authors.initials: P
authors.lastname: Buma
authors.forename: René P H
authors.initials: RP
authors.lastname: Veth
authors.forename: Tom J J H
authors.initials: TJ
authors.lastname: Slooff
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020959:Polyethylene / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D020959:Polyethylene