SpringerLink
Log in

Acetabular reconstruction using a free fibular autograft in total hip arthroplasty revisions

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Acetabular reconstruction for segmentary bone loss aims for primary stability and long-lasting integration. The use of a fibular autograft has been described after tumour resection and in traumatology. The hypothesis of this study is that it offers a mechanically reliable solution with good functional results and acceptable morbidity.

Methods

This is a two center retrospective study of 26 operated hips. Indication was mechanical loosening in every case. The operative technique included fibular grafting of a segmental bone loss associated with an acetabular metal reinforcement.

Results

Mean follow up was 88 months (three to 165). The PMA score increased from 8.5 (five to 12) to 15 (six to 18) (p <0.001). Acetabular migration was 2 mm (0–4) vertically and 1 mm (0–2) medially. Three graft failures were observed. No major morbidity was observed.

Conclusion

Fibular autograft after mechanical loosening and segmentary bone loss in total hip arthroplasty revisions offers a mechanically reliable solution for acetabular reconstruction. The results seem to be at least equivalent to other techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chen XD, Waddell JP, Morton J, Schemitsch EH (2005) Isolated acetabular revision after total hip arthroplasty: results at 5–9 years of follow-up. Int Orthop 29:277–280

    Article  PubMed Central  PubMed  Google Scholar 

  2. Hamadouche M, Karoubi M, Dumaine V, Courpied JP (2011) The use of fibre-based demineralised bone matrix in major acetabular reconstruction: surgical technique and preliminary results. Int Orthop 35:283–288

    Article  PubMed Central  PubMed  Google Scholar 

  3. Paprosky WG, Magnus RE (1994) Principles of bone grafting in revision total hip arthroplasty. Acetabular technique. Clin Orthop Relat Res 298:147–155

  4. Kawanabe K, Akiyama H, Onishi E, Nakamura T (2007) Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years. J Bone Joint Surg (Br) 89:26–31

    Article  CAS  Google Scholar 

  5. Sakai T, Ohzono K, Nishii T, Miki H, Takao M, Sugano N (2010) Grafting with hydroxyapatite granules for defects of acetabular bone at revision total hip replacement: a minimum ten-year follow-up. J Bone Joint Surg (Br) 92:1215–1221

    Article  CAS  Google Scholar 

  6. Saini R, Bali K, Bachhal V, Mootha AK, Dhillon MS, Gill SS (2011) En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature. J Orthop Surg Res 6:14

    Article  PubMed Central  PubMed  Google Scholar 

  7. Eward WC, Kontogeorgakos V, Levin LS, Brigman BE (2010) Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection. Clin Orthop Relat Res 468:590–598

    Article  PubMed Central  PubMed  Google Scholar 

  8. Mathoulin C, Gilbert A, Judet H, Judet T, Siguier M, Brumpt B (1993) Free transfer of the vascularized fibula in pseudarthrosis and femoral bone loss. Rev Chir Orthop Reparatrice Appar Mot 79:492–499

    CAS  PubMed  Google Scholar 

  9. D’Aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A:451–475

    PubMed  Google Scholar 

  10. Moreland JR, Greeen TA, Mai L, Amstutz HC (1980) Aseptic loosening of total hip replacement: incidence and significance. In The Hip. Proceedings of the eighth open scientific meeting of the hip society. CV Mosby and Co., St. Louis, MO

  11. D'Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–37

  12. Garbuz D, Morsi E, Mohamed N, Gross AE (1996) Classification and reconstruction in revision acetabular arthroplasty with bone stock deficiency. Clin Orthop Relat Res 324:98–107

  13. Nagoya S, Usui M, Wada T, Yamashita T, Ishii S (2000) Reconstruction and limb salvage using a free vascularised fibular graft for periacetabular malignant bone tumours. J Bone Joint Surg (Br) 82:1121–1124

    Article  CAS  Google Scholar 

  14. Campbell DG, Garbuz DS, Masri BA, Duncan CP (2001) Reliability of acetabular bone defect classification systems in revision total hip arthroplasty. J Arthroplasty 16:83–86

    Article  CAS  PubMed  Google Scholar 

  15. Robertson DD, Sutherland CJ, Lopes T, Yuan J (1998) Preoperative description of severe acetabular defects caused by failed total hip replacement. J Comput Assist Tomogr 22:444–449

    Article  CAS  PubMed  Google Scholar 

  16. Paprosky WG, Martin EL (2002) Structural acetabular allograft in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 31:481–484

    Google Scholar 

  17. Schreurs BW, Busch VJ, Welten ML, Verdonschot N, Slooff TJ, Gardeniers JW (2004) Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than 50 years old. J Bone Joint Surg Am 86-A:2385–2392

    PubMed  Google Scholar 

  18. Pereira GC, Kubiak EN, Levine B, Chen FS, Di Cesare PE (2007) Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups. Int Orthop 31:445–450

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Buttaro MA, Comba F, Pusso R, Piccaluga F (2008) Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res 466:2482–2490

    Article  PubMed Central  PubMed  Google Scholar 

  20. Busch VJ, Gardeniers JW, Verdonschot N, Slooff TJ, Schreurs BW (2011) Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than 50 years old: a concise follow-up, at 20 to 28 years, of a previous report. J Bone Joint Surg Am 93:367–371

    Article  PubMed  Google Scholar 

  21. Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168

    Article  PubMed  Google Scholar 

  22. Traina F, Giardina F, De Clerico M, Toni A (2005) Structural allograft and primary press-fit cup for severe acetabular deficiency. a minimum 6-year follow-up study. Int Orthop 29:135–139

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Jasty M, Harris WH (1990) Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts. J Bone Joint Surg (Br) 72:63–67

    CAS  Google Scholar 

  24. Beckmann NA, Weiss S, Klotz MC, Gondan M, Jaeger S, Bitsch RG (2014) Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 29(1):229–235

  25. Unger AS, Lewis RJ, Gruen T (2005) Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips. J Arthroplasty 20:1002–1009

    Article  PubMed  Google Scholar 

  26. Taylor GI, Miller GD, Ham FJ (1975) The free vascularized bone graft. a clinical extension of microvascular techniques. Plast Reconstr Surg 55:533–544

    Article  CAS  PubMed  Google Scholar 

  27. Bumbasirevic M, Stevanovic M, Bumbasirevic V, Lesic A, Atkinson HD (2014) Free vascularised fibular grafts in orthopaedics. Int Orthop 38(6):1277–1282

  28. Abuhassan FO, Shannak A (2010) Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC). Strateg Trauma Limb Reconstr 5:149–154

    Article  Google Scholar 

  29. Cook SD, Barrack RL, Patron LP, Salkeld SL (2003) Osteoinductive agents in reconstructive hip surgery: a look forward. Clin Orthop Relat Res 2003 417:195–202

  30. Tanaka C, Shikata J, Ikenaga M, Takahashi M (2003) Acetabular reconstruction using a Kerboull-type acetabular reinforcement device and hydroxyapatite granules: a 3- to 8-year follow-up study. J Arthroplasty 18:719–725

    Article  PubMed  Google Scholar 

  31. Akiyama H, Yamamoto K, Tsukanaka M, Kawanabe K, Otsuka H, So K, Goto K, Nakamura T (2011) Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device with bone allograft: minimum 4.5-year follow-up results and mechanical analysis. J Bone Joint Surg Br 93(9):1194–200

  32. Böhm P, Banzhaf S (1999) Acetabular revision with allograft bone. 103 revisions with 3 reconstruction alternatives, followed for 0.3-13 years. Acta Orthop Scand 70(3):240–249

  33. Massin P, Tanaka C, Huten D, Duparc J (1998) [Treatment of aseptic acetabular loosening by reconstruction combining bone graft and Müller ring. Actuarial analysis over 11 years]. Rev Chir Orthop Reparatrice Appar Mot 84(1):51–60

  34. Dua A, Kiran K, Malhotra R, Bhan S (2010) Acetabular reconstruction using fresh frozen bone allograft. Hip Int. 20(2):143–9

  35. Schreurs BW, Slooff TJ, Gardeniers JW, Buma P (2001) Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years’ experience. Clin Orthop Relat Res (393):202–15

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. University Hospital, 1 place Alexis Ricordeau, Nantes, France

    Thibaut Noailles, Francois Lintz, Sylvie Collon, Kevin Bargoin & Francois Gouin

  2. Kyoto City Hospital, Kyoto, Japan

    Chiaki Tanaka

Authors
  1. Thibaut Noailles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiaki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francois Lintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sylvie Collon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin Bargoin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francois Gouin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francois Gouin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noailles, T., Tanaka, C., Lintz, F. et al. Acetabular reconstruction using a free fibular autograft in total hip arthroplasty revisions. International Orthopaedics (SICOT) 38, 2447–2453 (2014). https://doi.org/10.1007/s00264-014-2439-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2439-2

Keywords

Search

Navigation