Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up

Paolo Domenico Parchi, Matteo Simonetti, Enrico Bonicoli, Nicola Piolanti and Michelangelo Scaglione
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Paolo Domenico Parchi: 1st Orthopedic Division, Department of Translational Research and new technology in medicine and surgery, University of Pisa, 56124 Pisa, Italy
Matteo Simonetti: 1st Orthopedic Division, Department of Translational Research and new technology in medicine and surgery, University of Pisa, 56124 Pisa, Italy
Enrico Bonicoli: 1st Orthopedic Division, Department of Translational Research and new technology in medicine and surgery, University of Pisa, 56124 Pisa, Italy
Nicola Piolanti: 1st Orthopedic Division, Department of Translational Research and new technology in medicine and surgery, University of Pisa, 56124 Pisa, Italy
Michelangelo Scaglione: 1st Orthopedic Division, Department of Translational Research and new technology in medicine and surgery, University of Pisa, 56124 Pisa, Italy

IJERPH, 2020, vol. 17, issue 15, 1-8

Abstract: Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.

Keywords: bone grafting; bone substitutes; total hip arthroplasty revision; acetabular cup; hydroxyapatite; osteointegration (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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