Treatment of Large Acetabular Defects: A Surgical Technique Utilizing Impaction Grafting into a Metallic Mesh

HSS Journal: Volume 9 Issue 3

Johannes Buckup, MD,
Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery

Emiliano Alvarez Salinas, MD,
Adult Reconstruction & Joint Replacement Division, Hospital Austral, Argentina

Alejandro Gonzalez Della Valle, MD

Alejandro Gonzalez Della Valle, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Friedrich Boettner, MD

Friedrich Boettner, MD

Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Abstract

Background
Revision total hip arthroplasty in cases with severe acetabular bone loss is challenging. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been the treatment of choice. The current paper describes an impaction grafting into a mesh for uncontained defects in revision total hip arthroplasty.

Description of Technique
After restoring containment with a mesh fixed with small fragment screws, defects were restored using impaction grafting combined with a cemented all-polyethylene cup.

Patients and Methods
Fourteen consecutive acetabular impaction graftings were performed by two surgeons. All patients had a type 3B defect according to the Paprosky classification.

Results
No re-revisions or radiographic failure was detected in the early follow-up period.

Conclusion
Impaction grafting into a mesh is an interesting treatment option to restore bone in combined cavitary and segmental defects.

This article appears in HSS Journal: Volume 9 Issue 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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