Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty

• Published in: Clinical orthopaedics and related research 2010-12, Vol.468 (12), p.3295-3303
• Main Authors: Lee, Paul T. H., Raz, Guy, Safir, Oleg A., Backstein, David J., Gross, Allan E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Bone Transplantation - adverse effects; Conservative Orthopedics; Graft Survival; Hip; Hip Joint - diagnostic imaging; Hip Joint - surgery; Hip Prosthesis; Humans; Kaplan-Meier Estimate; Medicine; Medicine & Public Health; Middle Aged; Ontario; Orthopedics; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society; Time Factors; Transplantation, Homologous; Treatment Outcome
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-010-1591-2

Background While acetabular structural allografts provide an important alternative for reconstructions, concerns remain with long-term graft resorption, collapse, and failure. Midterm studies of minor column (shelf) allograft suggest reasonable survival but long-term survival is unknown. Questions/purposes We therefore assessed long-term graft/cup survivorship, functional scores, radiographic resorption, and complications associated with minor column allograft. Methods We retrospectively reviewed 74 patients (85 hips) with a mean age of 54 years (range, 28–83 years) undergoing acetabular cup revision using a minor column allograft. A minor column allograft was used in uncontained acetabular bone defects sized between 30% and 50% of the acetabulum. Graft failure was considered to occur when the graft required revision with another graft, metal augment, reconstruction cage, or excision arthroplasty. The minimum followup was 5 years (mean, 16 years; range, 5.3–25 years). Results Twenty-three patients (27 hips) had rerevision for all causes at a mean time to rerevision of 6.9 years (range, 0.1–23). Fifteen grafts failed at a mean time-to-rerevision of 6.1 years (range, 0.5–23.2). The 15- and 20-year Kaplan-Meier survivorships were 61% and 55% for cups and 78% for grafts with rerevision for all causes as end point. With rerevision for aseptic loosening as end point, survivorships were 67% and 61% for cups and 81% for grafts. The mean modified Harris hip scores were 41 (range, 20–60) preoperatively, 73 (range, 40–95) at 1 year postoperatively and 73 (range, 26–93) at last followup. Conclusion The data may provide a long-term benchmark by which future treatments for Type III defects can be measured. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.