TY - JOUR
T1 - The fate of grafting acetabular defects during revision total hip arthroplasty
AU - Mall, Nathan A.
AU - Nunley, Ryan M.
AU - Smith, Kirk E.
AU - Maloney, William J.
AU - Clohisy, John C.
AU - Barrack, Robert L.
N1 - Funding Information:
One or more of the authors (RLB, JCC) or the authors’ institution has received funding from Medtronic Sofamor-Danek. One or more of the authors (RLB) has received royalties from Smith & Nephew Orthopaedics. One or more of the authors (WJM, JCC) has received royalties or funding from Wright Medical. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed at Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, MO.
PY - 2010/12
Y1 - 2010/12
N2 - Background: Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. Questions/purposes: We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. Methods: We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). Results: The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. Conclusions: Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing. Level of Evidence: Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.
AB - Background: Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. Questions/purposes: We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. Methods: We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). Results: The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. Conclusions: Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing. Level of Evidence: Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.
UR - http://www.scopus.com/inward/record.url?scp=78649327957&partnerID=8YFLogxK
U2 - 10.1007/s11999-010-1427-0
DO - 10.1007/s11999-010-1427-0
M3 - Article
C2 - 20577842
AN - SCOPUS:78649327957
SN - 0009-921X
VL - 468
SP - 3286
EP - 3294
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
IS - 12
ER -