Analysis Of The Short Results Of The Treatment For Acetabular Deficinencies In The Total Hip Replacement

Background Total hip replacement (THR) is presently one of the most effective surgeries to reconstruct the stability and mobility of hip joint, relieve pain and malformation. Acetabular deficiency is familiar in the total hip replacement. It can result from numerous causes, including congenital acetabular deficiency, such as development dysplasia of the hip and acetabular protrusion, infection, tumor. wear debris can activate a cellular cascade leading to bone resorption around an implant, which may lead to acetabular deficiency. As more revision total hip arthroplasties are encountered, the need for a systematic approach to diagnosis and treatment becomes more important. At present, many classification schemes have been formulated to describe acetabular deficiencies. The classification systems overseas referred to most often in the literature are those developed by the American Academy of Orthopaedic Surgeons (AAOS) Committee on the Hip, Engh et al., Gross et al., and Paprosky et al. At home professor Wang et al put forward Chong Qing classification of acetabular deficiency(CQAD). Objective The purpose of the study is to analyze the cases of THR for acetabular deficiency and the follow-up results to provide gist for intraoperative assessment of host bone stock, bone grafting,acetabular reconstruction and therapeutic effect. Methods 58 THR patients for acetabular deficiency who had received THR in our division during 1999.1-2004.1 were follow-up though the use of Harris hip score and radiographs of hip joint. Results 40 out of 58 acetabular deficiency patients reacted to our follow-up and provided intact follow-up information. The average duration of follow-up was 46.00 months (12-70 months). The average age was 56.50 years(23-75 years). There were 22 male and 18 female patients in 40 cases. The mean preoperative Harris hip score (HHS) was 26.50. The mean postoperative HHS had increased to 86.83. The therapeutic effect was fine (P<0.01). Our results showed that the mean HHS of acetabular deficiency caused by tumor had increased from 32.0 points preoperatively to 89.25 points (mean age 58.7 years) at the time of the final follow-up; acetabular deficiency caused by dysplasia from 28.25 points to 91.00 points (mean age 44.3 years); acetabular deficiency caused by fracture from 25.00points to 88.67 points (mean age 42.30 years); acetabular deficiency caused by revision from 25.14 points to 84.36 points (mean age 66.70years). Serial radiographs showed that morcellized bone grafting had incorporated in host bone at mean 3.18 months after operation; incorporation of the pedicle sartorius muscle iliac bone grafting at 3.3 months; incorporation of free autologous femoral head and iliac bone grafting at 4.34 months; But five allograft femoral head had not incorporated in host bone at 12-18 months after operation,it weren't resorbed and broke down. There were no sigficant differences between autologous and allograft morcellized bone grafting(P>0.05). The incorporation of the pedicle sartorius muscle iliac bone grafting and morcellized bone grafting was earlier than free autologous femoral head and iliac bone grafting(P<0.01); There were no sigficant differences between the pedicle sartorius muscle iliac bone grafting and allograft morcellized bone grafting(P>0.05). Conclusions This classification developed by professor Wang can simplify and standardize the evaluation of acetabular deficiency and guide treatment well. The good result is come from the application of morselized bone for cavitary deficiency, The incorporation is earlier than autologous structure bone grafting. There are no sigficant differences between autologous and allograft morcellized bone grafting. As a kind of vital bone grafting, the pedicle sartorius muscle iliac bone grafting for reconstruction of acetabular deficiencies can attain better bone formation. Structural allograft is used to provide a mechanical environment that supports host bone ingrowth into an acetabular component. it wan't resorbed and broke down.But the incorporation is slower than autologous structure bone grafting.