[Reconstruction of the acetabulum with structured bone graft in press-fit technique].
OBJECTIVE
Reconstruction of defects of the superior acetabular rim with structured bone grafts in press-fit technique before total hip replacement.


METHODS
Defects of the superior acetabular rim following hip dysplasia Crowe type II-IV, avascular necrosis of the femoral head Ficat stage IV, or aseptic loosening of the cup with acetabular defects Paprosky type 2a and 2b.


METHODS
Acetabular defects Paprosky type 2c, 3a and 3b, septic loosening, severe osteoporosis.


METHODS
Exposure of the acetabular defect and debridement with a spherical reamer to create a concave bleeding graft bed. Shaping of the bone graft with an inverted reamer of corresponding size and oscillating saw. Press-fit insertion of the bone graft into the defect and temporary fixation with Kirschner wires. Rereaming of the acetabulum with the spherical reamer. Implantation of a cemented cup of corresponding size. Removal of Kirschner wires after setting of cement.


METHODS
Full weight bearing in case of small or medium graft, 6-week non-weight bearing in case of big load-bearing graft. Mobilization on 1st day postoperatively. Stair climbing on 7th day postoperatively. Suture removal after 10 days.


RESULTS
In 46 patients with 55 total hip replacements with structured grafts in press-fit technique, the Harris Hip Score improved from 38.9 points to 92.3 points after 29.4 months (12.0-84.4 months). There were two cases of delayed wound healing and one cup exchange because of aseptic loosening. Radiologically, one graft sintering by 5 mm was detected.
Halder
Andreas
A
Klinik für Endoprothetik, Sana Kliniken, Sommerfeld, Germany. a.halder@sana-hu.de
Beier
Alexander
A
Neumann
Wolfram
W
D000077:Acetabulum / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D016025:Bone Transplantation / Q000295:instrumentation*; D003646:Debridement / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D016896:Treatment Outcome