The Biological Approach in Acetabular Revision Surgery: Impaction Bone Grafting and a Cemented Cup

Abstract

Acetabular impaction bone grafting (IBG) in combination with a cemented cup in revision total hip arthroplasty (THA) is a proven and well-recognised technique which has been used in clinical practice for more than 35 years. Nowadays, with cemented prostheses tending to lose a larger part of the THA market every year in primary and revision cases, and many young surgeons being only trained in implanting uncemented prostheses, this technique is considered by many as technically demanding and time consuming, making its use less appealing. Despite this image and many new innovative techniques using uncemented implants in acetabular revisions over the last 25 years, IBG with a cemented cup is still one of the few techniques that really can reconstitute bone and respects human biology. In this era of many biologically-based breakthroughs in medicine, it is hard to explain that the solution of most orthopaedic surgeons for the extensive bone defects as frequently seen during acetabular revision surgery, consists of implanting bigger and larger metal implants. This review aims to put the IBG method into a historical perspective, to describe the surgical technique and present the clinical results.

A 2- to 16-Year Clinical Follow-Up of Revision Total Hip Arthroplasty Using a New Acetabular Implant Combined With Impacted Bone Allografts and a Cemented Cup

“…For results from the literature on different acetabular revision methods, see Table 3. IBG is considered technically demanding and the method includes a learning curve [38]. The graft distributing method called reverse reamingdwhen an acetabular reamer is driven in reverse direction towards particulated bone graftdis inadequate in terms of impaction force.…”

Is two-stage revision surgery for infected hip arthroplasty worth the suffering, resources and results compared to one-stage?

“…Impaction bone grafting is the only method that can restore bone loss caused by osteolysis. 12,13 In addition, morcellised bone graft can be used as a carrier for antibiotics. 14,15 1 gram of vancomycin powder per morcellised femoral head provides local concentrations at 50-300 times above the minimum inhibitory concentration (MIC) for 2-3 weeks.…”

Azetabuläre Revision: Rekonstruktion kavitärer und segmentaler Defekte unter besonderer Berücksichtigung modularer hoch poröser Pfannensysteme

“…This article provides an overview of relevant literature and implant-specific features of different reconstruction strategies. [3,4]. Zur Versorgung azetabulärer Defektsituationen sind eine Vielzahl von Therapiestrategien beschrieben [5,6].…”