title: Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip.
abstract: BACKGROUND
  The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure.
  
  
  METHODS
  Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four.
  
  
  RESULTS
  Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation.
  
  
  CONCLUSIONS
  We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan. seneki@hsp.md.shinshu-u.ac.jp
authors.forename: Seneki
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Naoto
authors.initials: N
authors.lastname: Saito
authors.forename: Masashi
authors.initials: M
authors.lastname: Nawata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Horiuchi
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.forename: Kunio
authors.initials: K
authors.lastname: Takaoka
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005270:Femur Head / Q000637:transplantation*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome