Structrual Autograft For Acetabular Reconstruction In Total Hip Arthroplasty Of Developmental Dysplasia Of The Hip

Background:Developmental Dysplasia of the Hip (DDH) is a relatively common disease and total hip arthroplasty (THA) for the treatment of it can get satisfactory results.Due to lack of coverage, there can be a defect in patients with DDH in the process of THA. To manage this bone deficiency problem, bulk femoral head structural autograft for acetabula reconstruction has its advantages of installing the prosthesis at the level of true acetabulum and providing it with satisfactory coverage and stability.Objective:To evaluate the result of structural autograft for actabular reconstruction in THA for DDH patients with severe actabular deficiency and to test and study influence of operational result from bone graft coverage and reconstructive level.Methods:25patients(31hips) with development hip dysplasia were performed with bulk femoral head autograft for actabular reconstruction in THA during2005-2010.29hips in23patients were successfully followed up in average5.1years with mean age of52. According to Crowe rating,18hips in15patients were stage III with11hips in8patients as stage IV. The deficient acetabula were reconstructed by bulk femoral head autograft. With bone coverage guaranteed, patients had prothesis installed at original or closed level of true acetabulum. Radiographic changes and Harris scores were evaluated.Results:None had suffered loosening and collapse during the follow-up. One was revised for dislocation. Graft bones heal satisfactorily and bone interface disappeared with trabecular reorientation. Sockets were stable and bone volume unchanged. Harris scores increased from44preoperative to89the first year after operation, and to88at last follow-up. From the grouping study of relationship between graft coverage rate and Harris scores, relatively safe graft coverage rate is evaluated as less than35%.Conclusion:To reconstruct acetabulum at true acetabula level with satisfactory bone coverage by using bulk femoral head autograft is an effective and safe way for THA in DDH. Pseudoacetabulua and bulk femoral head for graft need to be delicately handled in the operation. To those host bone coverage more than50%, acetabula should be reconstructed at the original level; and to those hardly reach the standard, reconstructive location can be chosen to the level near the original. The safe graft coverage rate is evaluated at less than35%, basically equaling the general approval range of30-40%.