Structural Autograft For Acetabular Reconstruction In Total Hip Arthroplasty Of Crowe â…¢ And â…£ Type Developmental Dysplasia Of The Hip In Adult

Backgroung:Severe acetabular deficiencies in casses of developmental dysplasia of the hip (DDH) often require complex reconstructive procedures in total hip arthroplasty(THA). The use of autologous femoral head grafts for acetabular reconstruction can provide reliable acetabular coverage and stability. But higher rates of mechanical failure have been reported in this group.Objective:To evaluate the result of structural autograft for acetabular reconstruction in THA for Crowe III and IV type development dysplasia of hip (DDH).Method:Patients with Crowe III and IV type developmental dysplasia of the hip (DDH)(26cases of32hip)accept total hip arthroplasty(THA) and the bulk femoral head autograft for acetabular reconstruction were used in all patients during January in2005to December in2011in our Joint department. Results of all patients were followed up for5.2years in24cases of30hips, including15cases19hips CroweⅢ type, Crowe IV type11hips9cases, with an average age of52. The degree of the defect in the acetabulum and the quality of the surrounding bone and femoral head were assessed by using preoperative imaging examinations. Small acetabulum file were used to deal with acetabulum bone graft bed and the bulk femoral head autogograft. Postoperative radiographic examination were used to observe the bone graft fusion、the change of the imaging of the acetabulum prosthesis and Harris function score, we access the effect of the surgery with preoperative Harris scorer and the last follow-up. Result:All cases were followed up in which1case1hip underwent a revision total hip arthroplasty due to the dislocation. There was sciatic nerve injury in one case, which partially restored after conservative treatment for1month. Acetabulum prosthesis loosening and loose bone graft bone resorption was not found in the rest of the follow-up cases. Imaging examinations denote that acetabulum bone graft fuse with the host bone, and that contact surface disappeared and trabecular bone reconstruction.No shift of the acetabulum prosthesis was found.The rate of bone implant prosthesis coverage was66.2%, namely the rate of the acetabulum bone graft coverage was33.8%, and follow-up of patients with preoperative Harris score was44.36, Harris score after1year was89.3points, significantly higher than that of preoperative, with statistical significance. The last follow-up Harris score was87.9points. According to Harris scoring reaction postoperative effect,90%of patients have good effect.Conclusion:To reconstruct acetabulm at ture acetabula level with satisfactory bone coverage (30-40%) by using bulk femoral head for autograft is an effective method for THA in DDH. It inproves symptoms and functions.Structural bone-grafting can provide reliable acetabular coverage and restore bone stock. This method can restore normal level of rotating center of the acetabulum. Small acetabulum file were used to process a mortar in advance and bone graft blocks were dressed, could harvest satisfactory consequence.