ACETABULAR REVISION WITH ARMATURE,
ALLOGRAFTS AND CEMENTED PROSTHESIS
M. Kerboull
This technique of acetabular reconstruction in failed total hips was developed 30 years ago in
1974. Since then, it has efficiently stood the test of time, even in the most severe cases of
bone loss. Its goal is to reconstruct a bony cavity of normal size in anatomic position into
which a standard acetabular component is cemented. Bone reconstruction is composed of
fragments of a frozen femoral head: a bulky piece carefully shaped to repair the damaged
roof; slices to reconstruct or thicken medial, anterior and posterior walls; morcellized
cancellous bone to fill cavitary defects and gaps between structural grafts. This bony
reconstruction is reinforced with a metallic cross-shaped armature which is fastened to the
bone by its inferior hook and superior screws. This device which also acts as a guide for
bone reconstruction, automatically provides the artificial hip with the right anatomical centre.
It is stiff enough to secure a pelvic discontinuity, but because it is open, it remains flexible
and does not change the elasticity of the acetabulum.
Wide and complex reconstructions can be carried out with this technique. On over 2000
cases operated on in the Orthopaedic Department of Cochin-Hospital Paris, and on 700
cases by myself, since 1974, we always managed to repair the acetabular bone defects even
in type IV AAOS with a pelvic discontinuity. Postoperatively, within one year after surgery,
grafts have united together and with the host bone. At 2 years, the progressive remodelling
of the grafts is obvious in the superior as well as inner part, indicating that they are probably
mechanically and biologically incorporated. At long term, there has been up to now no
serious problem. In 57 cases there has been no resorption of the graft, no loosening of the
socket. In 3 cases a resorption of the graft has been seen, twice due to osteolysis related to
polyethylene wear, once to an immunologic problem on a patient who had developed
antibodies against HLA of the graft.
The outcome of this type of acetabular reconstruction was published in the Clinical
Orthopaedics and Related Research 4 years ago. On a series of 60 acetabular
reconstructions with severe bone loss (AAOS type III for 48 hips and type IV for 12) operated
on from 1976 to 1986 and reviewed with a mean follow up of 12 years (5 to 24 years), clinical
results were satisfactory for 90 % of the patients. Ninety-five percent were radiologically
successful; there were 3 failures (5 %) due to resorption of the graft and socket loosening. In
any case, with a 92 % survival rate at 16 years (acetabular component loosening as end
point) this technique seems valuable and reliable even at long term.