The Journal of Bone and Joint Surgery, Vol 77, Issue 12 1829-1835, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Early failure of acetabular components inserted without cement after previous pelvic irradiation
JJ Jacobs, LR Kull, GA Frey, S Gitelis, MB Sheinkop, TS Kramer and AG Rosenberg
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
The effect of previous irradiation of the pelvis on the survival of
acetabular components inserted without cement in primary total hip
arthroplasty was examined. We searched a database of 1319 patients who had
been managed with a primary total hip arthroplasty with insertion of a
hemispherical porous-coated acetabular component without cement. This
revealed twelve hips in eleven patients who had been managed with previous
irradiation of the pelvis. Three patients had died after less than one year
of follow-up, leaving eight patients with nine acetabular components
available for study at an average of thirty-seven months (range, seventeen
to seventy-eight months) after the operation. The type of radiation as well
as the fractionation, dose, and portals were reviewed to determine the
exposure of the periacetabular region to radiation. Failure of the
component was assessed radiographically and clinically. At the time of
follow-up, three of the nine acetabular components had migrated, as seen on
radiographs, and had been associated with progressive radiolucency without
clinical symptoms. Thus, four of the nine acetabular components failed, at
an average of twenty-five months (range, sixteen to thirty-eight months).
The other five components had not failed clinically and were stable
radiographically at an average of thirty-six months (range, seventeen to
sixty-three months). The insertion of acetabular components without cement
in a previously irradiated pelvis has a high rate of failure. However, a
superior method of acetabular reconstruction in this difficult situation
has yet to emerge.
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