title: Grafting with hydroxyapatite granules for defects of acetabular bone at revision total hip replacement: a minimum ten-year follow-up.
abstract: The long-term results of grafting with hydroxyapatite granules for acetabular deficiency in revision total hip replacement are not well known. We have evaluated the results of revision using a modular cup with hydroxyapatite grafting for Paprosky type 2 and 3 acetabular defects at a minimum of ten years' follow-up. We retrospectively reviewed 49 acetabular revisions at a mean of 135 months (120 to 178). There was one type 2B, ten 2C, 28 3A and ten 3B hips. With loosening as the endpoint, the survival rate was 74.2% (95% confidence interval 58.3 to 90.1). Radiologically, four of the type 3A hips (14%) and six of the type 3B hips (60%) showed aseptic loosening with collapse of the hydroxyapatite layer, whereas no loosening occurred in type 2 hips. There was consolidation of the hydroxyapatite layer in 33 hips (66%). Loosening was detected in nine of 29 hips (31%) without cement and in one of 20 hips (5%) with cement (p = 0.03, Fisher's exact probability test). The linear wear and annual wear rate did not correlate with loosening. These results suggest that the long-term results of hydroxyapatite grafting with cement for type 2 and 3A hips are encouraging.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan. tsakai-osk@umin.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Sakai
authors.forename: K
authors.initials: K
authors.lastname: Ohzono
authors.forename: T
authors.initials: T
authors.lastname: Nishii
authors.forename: H
authors.initials: H
authors.lastname: Miki
authors.forename: M
authors.initials: M
authors.lastname: Takao
authors.forename: N
authors.initials: N
authors.lastname: Sugano
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000401:mortality; D016025:Bone Transplantation / Q000379:methods*; D002484:Cementation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016019:Survival Analysis
chemical_list: D006882:Hydroxyapatites; C475044:hydroxyapatite cement