The Journal of Bone and Joint Surgery, Vol 72, Issue 2 248-251, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Bone-grafting in total hip arthroplasty for protrusio acetabuli. A follow-up note
HS Gates, DE McCollum, SC Poletti and JA Nunley
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710.
The results of total hip arthroplasty with the use of medial and superior
bone-graft augmentation in thirty-nine hips (thirty-two patients) that had
protrusio acetabuli were previously reported after two to eight years
(mean, 4.7 years) of follow-up. We followed the surviving patients for 10.9
to 17.4 years (mean, 12.8 years). The average Harris hip-rating was 72
points--an average drop of 17 points since the previous report. The average
was 64 points for patients who had rheumatoid arthritis and 83 points for
those who had another diagnosis. Radiographic evaluation demonstrated
definite, probable, and possible loosening in about 20, 10, and 60 per cent
of the hips, respectively. Of the six hips that had definite loosening,
four (10 per cent of the total series) had progression of the protrusion
(acetabular migration); operative revision was performed on two of those
four hips and on two other hips, in which progression had ceased. Hips that
had progressive protrusion demonstrated superior migration more often than
medial migration. The rates of loosening and revision were similar to those
in hips that did not have protrusio acetabuli. We concluded that
augmentation of total hip arthroplasty with bone-grafting is effective in
arresting the progression of protrusio acetabuli in most hips (90 per cent
in our series).
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