BACKGROUND: Bone defects in patients who have developmental dysplasia of the hip (DDH) often preclude standard acetabular reconstruction during total hip arthroplasty (THA). Autogenous femoral head structural bone grafts (SBGs) provide good acetabular component coverage, but are associated with resorption or collapse of the grafted bone and loosening of the implant. Autogenous cancellous bone impaction grafts (CBIGs) are believed to promote faster remodeling with comparable outcomes of greater than 12 years. This study compared the clinical outcomes and graft content of these two techniques for at least 12 years.
METHODS: This retrospective comparative study analyzed 18 THAs using CBIG and 17 using SBG performed between 2008 and 2012 for Crowe types III and IV DDH. The mean follow-up periods were 14.5 (range, 12 to 17) and 15 (range, 13 to 17) years for CBIG and SBG recipients, respectively. Operative time was significantly shorter for CBIG than for SBG (86 ± 14 versus 105 ± 20 minutes, P = 0.003). Complications, clinical outcomes, radiographic evaluations, and total osteolysis volume in the grafted bone on computed tomography images were assessed until the final follow-up.
RESULTS: Bridging trabeculation, graft remodeling, and trabecular reorientation were significantly faster in CBIG than in SBG (P < 0.001). The extent of bone graft resorption was less pronounced in CBIG than in SBG (P = 0.001). Bone ingrowth confirmed implant stability in all assessed joints. The total osteolysis volume was significantly lower in the CBIG group (0.15 ± 0.2 cm3) than in the SBG group (0.59 ± 0.31; P = 0.004).
CONCLUSION: The CBIG is a viable option for patients who have Crowe types III and IV DDH, demonstrating similar outcomes to those of SBG for at least 12 years and faster postoperative integration to the host bone with reduced osteolysis.
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