Use of Bipolar Prosthesis and Bone Graft to Treat Failed Total Hip Replacement with Severe Acetabular Bone Deficiency

When total hip replacement fails in conjunction with loosening of the acetabular component, revision surgery is needed. The efficacy of a revision technique involving the insertion of a bipolar prosthesis and allograft was test-ed. Fourteen acetabular reconstructions for severe bone deficiency in failed total hip replacement using a bipolar prosthesis and allograft were performed between 1997 and 1999. There were 3 Type I (segmental), 8 Type II (cavitary), and 3 Type III (combined) defects. The largest possible bipolar head was used to obtain maximum rim contact around the acetabulum. Bone grafts consisted of morselized bone and bone blocks used singly or in combination. The average age of patients at the time of revision was 59 years (range, 51 to 75). The follow-up period was 18 to 46 months, for an average of 26 months. The average Harris hip score was 50 points preoperatively and 82 points at the latest follow-up examination. All grafts were incorporated by 6 months postoperatively. No sig-nificant component migration (less than 3 mm) has occurred in eleven hips. Contusion of the sciatic nerve occurred in one case. At the time of reporting, no patients had required a second operation. Reconstruction for severe acetabular defects using this technique is an alter-native procedure for dealing with this difficult condition. Short-term results are satisfactory. Incorporated bone grafts provide supplementation of bone stock when a second-stage reconstruction is necessary. The procedure may be defini-tive in some patients. Long-term follow-up is needed for full assessment.

並列關鍵字

Total hip arthroplasty ； Revision ； Bipolar prosthesis ； Allograft

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