title: Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device with bone allograft: minimum 4.5-year follow-up results and mechanical analysis.
abstract: We retrospectively reviewed 40 hips in 36 patients who had undergone acetabular reconstruction using a titanium Kerboull-type acetabular reinforcement device with bone allografts between May 2001 and April 2006. Impacted bone allografts were used for the management of American Academy of Orthopaedic Surgeons Type II defects in 17 hips, and bulk bone allografts together with impacted allografts were used for the management of Type III defects in 23 hips. A total of five hips showed radiological failure at a mean follow-up of 6.7 years (4.5 to 9.3), two of which were infected. The mean pre-operative Merle d'Aubigné score was 10 (5 to 15) vs 13.6 (9 to 18) at the latest follow-up. The Kaplan-Meier survival rate at ten years, calculated using radiological failure or revision of the acetabular component for any reason as the endpoint, was 87% (95% confidence interval 76.3 to 97.7). A separate experimental analysis of the mechanical properties of the device and the load-displacement properties of bone grafts showed that a structurally hard allograft resected from femoral heads of patients with osteoarthritis should be preferentially used in any type of defect. If impacted bone allografts were used, a bone graft thickness of < 25 mm was acceptable in Type II defects. This clinical study indicates that revision total hip replacement using the Kerboull-type acetabular reinforcement device with bone allografts yielded satisfactory mid-term results.
authors.affiliation: Kobe City Medical Center General Hospital, Department of Orthopaedics, 4-6, Minatojimanakamachi, Chuo-ku, Kobe-City, Hyogo 650-0046, Japan. hakiyama@kuhp.kyoto-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: K
authors.initials: K
authors.lastname: Yamamoto
authors.forename: M
authors.initials: M
authors.lastname: Tsukanaka
authors.forename: K
authors.initials: K
authors.lastname: Kawanabe
authors.forename: H
authors.initials: H
authors.lastname: Otsuka
authors.forename: K
authors.initials: K
authors.lastname: So
authors.forename: K
authors.initials: K
authors.lastname: Goto
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods; D016025:Bone Transplantation / Q000379:methods*; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome