The Treatment Of Acetabular Defects In Primary Total Hip Arthroplasty

Objective:Observing the clinical effects of acetabular reconstruction which was used with the autologous femoral head in primary total hip arthroplasty, we summarized the methods and experience in order to provide guidance and reference for clinical treatment.Methods:35cases of patients with acetabular defects were treated with primary total hip arthroplasty from May2009to August2012, in which21cases were developmental dysplasia of hip,6cases were necrosis of femoral head,7cases were pure osteoarthritis, and only1case was traumatic arthritis. According to the American Academy of Orthropedic Surgons, we classified the41cases to3groups, which included20cases type Ⅰ,16cases of type Ⅱ and5cases of type Ⅲ. Type Ⅰ and Ⅱ were treated with impaction bone graft with morserlised bone of autologous femoral head. Type Ⅲ was treated with structural bone graft with autologous femoral head. Thought outpatient reexamination, we evaluated the postoperation complications, prosthesis loosening and bone graft healing. According to the Harris hip score, the recovery was divided into poor four, common, good and excellent levels, and finally we calculated group’s excellent rate.Results:The incisions were all first-stage healing, and no infection and nerve injury happened. And one patient happened with pulmonary embolism. The average follow-up was22(9～42) months, the mean Harris score was enhanced from46.3to91.8point (P<0.01). There was no prosthesis loosening and revision. There were4cases with radiolucent llines around the prosthesis of which2cases were necrosis of femoral head and2cases were developmental dysplasia of hip. And then we did not found the radiolucent was enlarged in the follow-up.Conclusion:For the patients with acetabular defect(AAOS type Ⅰ～typeⅡ) in primary THA, autograft femoral head could achieve good clinical effects when we made the acetabular reconstruction according to the type of the acetabular defects. The surgery should be finished by the experienced surgeons. And choosing the good cancellous bone of femoral head without cartilage or the allograft bone was a good choice, for the acetabular construction of primary total hip arthroplasty(THA). And the preoperative planning was important for THA.