title: Acetabular bone defects in THA revision: Reconstruction using morsellised virus-inactivated bone allograft and reinforcement ring. Seven-year outcomes in 95 patients.
abstract: Acetabular cup loosening is among the main reasons for revision total hip arthroplasty (THA). The implantation of a cryopreserved morsellised bone allograft is a reference method for filling bone defects. However, the outcomes of bone grafts treated with viral inactivation and secured into the host bone (notably using a reinforcement device) are unclear. We therefore retrospectively reviewed cases of acetabular revision with morsellised bone allograft implanted into a reinforcement ring for acetabular revision to assess: (1) clinical survival of the acetabular implant (time to new revision with acetabular component removal), (2) radiological implant survival, (3) and bone graft osseointegration evaluated using Oswestry's criteria.
  
  
  
  Virus-inactivated bone allografts provide similar outcomes to cryopreserved allografts.
  
  
  
  From 2004 to 2009, 95 patients underwent acetabular revision. There were 60 (63%) females and 35 (37%) males with a mean age of 71.7 years (range: 44.2-90 years). Over 90% of patients had bone defects type 2 or higher in the AAOS classification. Each patient was evaluated after at least 5 years, by an examiner who had not been involved in the revision and who determined the Postel-Merle d'Aubigné (PMA) score and patient satisfaction. We assessed the clinical survival of the acetabular implant (time to new revision with acetabular implant removal), radiological implant survival (migration>5mm, active radiolucent line, failure of graft osseointegration, or reinforcement ring failure), and allograft osteointegration evaluated using Oswestry's criteria.
  
  
  
  After a mean follow-up of 7years (range: 5.2-10years), 7 (7.4%) patients had been lost to follow-up and 3 (3.4%) had required surgical revision, after 3 to 73 months (for aseptic loosening in 2 cases and infection in 1 case). The estimated 10-year survival rate was 96.2% (95% confidence interval [95%CI]: 88.2-98.7). The mean PMA score at last follow-up had increased significantly, by 2.8 points (p<0.05), to 13.8 (95%CI: 78.4-88.1). Of the 88 re-evaluated patients, 78 (89%) were satisfied or very satisfied. The overall radiological survival rate was 84.5% (95%CI: 78.4-88.1) after a mean of 5.9 years (range: 0.5-10). Allograft osseointegration was satisfactory (Oswestry score≥2) in 95.8% of patients.
  
  
  
  In our population, allografts previously subjected to virus inactivation and implanted into a reinforcement ring produced outcomes similar to those reported previously with cryopreserved allografts.
  
  
  
  IV, retrospective case-series study.
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France. Electronic address: guillaumevillatte@hotmail.fr.
authors.forename: G
authors.initials: G
authors.lastname: Villatte
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France.
authors.forename: R
authors.initials: R
authors.lastname: Erivan
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
authors.forename: G
authors.initials: G
authors.lastname: Salles
authors.affiliation: Service de biostatistiques et épidémiologie, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Galvin
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France.
authors.forename: S
authors.initials: S
authors.lastname: Descamps
authors.affiliation: Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France.
authors.forename: S
authors.initials: S
authors.lastname: Boisgard
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: Acetabular revision; Bone defect; Outcomes; Total hip arthroplasty; Virus-inactivated bone allograft