Acetabular impaction bone grafting for chronic pelvic discontinuity

Background

Acetabular impaction bone grafting is an attractive technique in hip revision surgery. There are over 40 years of clinical experience with this technique combined with a cemented cup. ^, Recent studies have also published results regarding the successful application of this method with uncemented cups. ^, Impaction bone grafting is the only technique that really restores bone stock deficiencies. Several studies have proven the incorporation of these allografts into normal bone. ^,

It is clear that impaction bone grafting in cavitary defects is very successful. In more extensive defects, the technique of bone impaction is more demanding, and clinical outcomes are not always reproducible. However, other reports have demonstrated excellent outcomes using this technique in Paprosky type IIIB defects. ^, Our group has reported the use of this technique in larger defects, mainly Paprosky IIIA and IIIB defects, with satisfying results - a ten-year survival rate of 88% with using revision for any reason as an endpoint.

The big unsolved problem that still faces revision hip surgeons is performing revisions in young patients. Orthopedic surgeons continue to increase the number of total hip arthroplasty (THA) procedures performed annually in patients under 55 years; however, there is a lack of literature on revision outcomes in this young patient group. Data on the outcome of revision procedures in young patients using uncemented implants are limited and disappointing. ^, For primary reconstructions in younger patients, acetabular impaction bone grafting is a very attractive option, also in more extensive defects. Scenarios with a large superolateral defect often require this technique to be combined with a mesh, and, if needed, the mesh can be reinforced with a plate. In special cases, these meshes can be combined with an additional structural bulk graft, typically a femoral head allograft. Due to restoration of bone stock, successive acetabular reconstructions following impaction bone grafting can be performed with favorable implant survivorship at ten years. ^,

Premise: In cases with massive defects associated with chronic pelvic discontinuity, a biological solution using impacted bone grafts is still possible; however, recognition of the mechanical problem associated with discontinuity is essential. The discontinuity must be bridged by a plate, as the use of a mesh for reconstruction only is not sufficient. The plates can be used on the inner wall of the acetabulum or applied externally. Once the discontinuity has been stabilized, the impaction bone grafting technique can be performed. In this chapter, we detail the technique of impaction bone grafting for use in massive acetabular defects with an associated chronic pelvic discontinuity.

Surgical technique