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The Journal of Bone and Joint Surgery (American) 85:615-621 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Total Hip Arthroplasty with Bulk Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip

Seneki Kobayashi, MD, PhD, Naoto Saito, MD, PhD, Masashi Nawata, MD, Hiroshi Horiuchi, MD, Richard Iorio, MD and Kunio Takaoka, MD, PhD

Investigation performed at the Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan, and the Department of Orthopaedic Surgery, Lahey Clinic, Burlington, Massachusetts

Seneki Kobayashi, MD, PhD
Naoto Saito, MD, PhD
Masashi Nawata, MD
Hiroshi Horiuchi, MD
Kunio Takaoka, MD, PhD
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan. E-mail address for S. Kobayashi: seneki{at}hsp.md.shinshu-u.ac.jp

Richard Iorio, MD
Department of Orthopaedic Surgery, Lahey Clinic, 41 Mall Road, Box 541, Burlington, MA 01805

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure.

Methods: Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four.

Results: Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation.

Conclusions: We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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