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Hip Replacement
Filling Acetabular Defects with Preformed Demineralized
Bone Matrix in Revision Total Hip Arthroplasty
Norman A. Johanson, M.D., Douglas L. Cerynik, M.D.
Department of Orthopaedic Surgery, HahnemannUniversityHospital,
Philadelphia, PA
 Introduction
Osteolysis with aseptic loosening is an increasingly common
long-term complication of primary total hip arthroplasty (THA).
Particulate wear debris originating from polyethylene acetabul
ar liners is a common source of large osteolytic defects that
are encountered during revision surgery.1Aseptic loosening
of components secondary to resorption of cancellous bone grafts
has been noted.2 Although demineralized bone matrix (DBM)
mixed with cancellous bone chips has shown promising results,
the outcomes of malleable preformed bone graft substitutes
that include DBM has not been published. In this study, we
review 2 patients who have undergone revision THA using malleable
bone graft substitutes to fill large contained osteolytic
acetabular defects. |
Case Reviews
Case 1
A 64-year-old male, with 2 prior right hip revisions, presented
with persistent right hip pain increasing in intensity over the
last 2-3 months and 1 inch shortening of the right lower limb. Radiographs
of the right hip showed an all polyethylene socket, wire mesh from
a prior revision using impaction grafting technique and a well-fixed
cemented stem with a high hip center. CT of the affected side revealed
a large contained acetabular defect.
The patient underwent revision surgery of the right acetabular component
with bone graft substitute (AccellTotal Bone Matrix®, IsoTis
OrthoBiologics, Inc., Irvine, CA) placed in the defect and a cementless
acetabulum without screw fixation.
Case 2
A 72-year-old male with a right total hip arthroplasty done 20 years
ago presented with a limp and right lower limb shortening of 1 inch.
Radiographs showed an osteolytic defect in the right acetabulum
with superior wear of the polyethylene liner.
The patient underwent revision surgery of the acetabular component
to a large cementless cup with demineralized bone matrix (Accell
Total Bone Matrix®, IsoTis OrthoBiologics, Irvine, CA) used
to fill the defect.
Results / Discussion
The use of malleable pre-formed bone graft substitutes in filling
large osteolytic and non-osteolytic induced defects of the acetabulum
appears to be a viable option in revision THA. Short-term radiographic
evidence shows healing of the defects with increasing density in
the affected area.
References
1. Willert HG, Bertram H, Buchorn GH: Osteolysis in alloarthroplasty
of the hip. Clin Orthop1990;258:95-107.
2. Leopold SS, Jacobs JJ, Rosenberg AG: Cancellous allograft in
revision total hip arthroplasty. A clinical review.
Clin Orthop Relat Res.2000;371:86-97.
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