Revista de la Asociación Argentina de Ortopedia y Traumatología
versión On-line ISSN 1852-7434
LOPREITE, Fernando A.; LLOYD, Ruy y DEL SEL, Hernán J.. Acetabular reconstruction with impacted morselized bone graft. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2009, vol.74, n.4, pp. 324-330. ISSN 1852-7434.
Background: The purpose of the study is to review a consecutive series of acetabular reconstructions using the Slooff technique, and to establish its usefulness in different types of acetabular defects. Methods: The study group included 61 revisions in 60 patients. Mean follow up was 68 months (60-120); mean age: 66 years (39-88); 17 males (28.33%) and 43 females (81.66%). The Merle d'Aubigne and Postel scale was used for clinical assessment. Each case was classified according to Paprosky's acetabular defects classification. Non-irradiated frozen impacted allograft and cemented acetabular components were used, according to the original Slooff technique. Horizontal and vertical migration was evaluated on the tear drop image. Radiographs were taken immediately after surgery and 1, 3, 6 months and annually post-op. Allograft incorporation criteria were established as: trabecular remodeling, and architecture and density similar to native bone. Reconstruction failure was considered as: 4 mm cup migration or 5° angulation. Results: Of the 61 cups reviewed on 60 patients, 48 (78.6%) were type II defects (IIA 11 cases - IIB 10 cases- IIC 27 cases); allograft healing with trabecular remodeling was seen in 46 cases (96%) between the third and sixth month post-op. The pre-op mean clinical assessment was 9.2 ± 0.6, and changed to 16.1 ± 0.9 after the procedure. Thirteen cases (21%) were classified as Paprosky type III defects (IIIA 8 cases - IIIB 5 cases). Radiological failure was detected in ten. In most of the cases graft resorption was noted between months 12 and 24, with construction collapse. The mean clinical assessment before surgery was 5.3± 0.4 and changed to 9.3 ± 1.17 after the procedure. Conclusions: Paprosky classification separates bony type II defects from type III based on acetabular migration. Those whose migration exceeds 2 cm are classified as type III. Acetabular reconstruction with impacted morselized cancellous bone graft and cement, used on Paprosky type II defects achieved excellent results. The same surgical technique for Paprosky type III defects resulted in high failure rate, without the use of a reinforcement ring.
Palabras clave : Acetabular reconstruction; Impacted morselized allogeneic bone graft; Slooff technique; Acetabular defects.