ACETABULAR RECONSTRUCTION WITH A BIPOLAR PROSTHESIS AND MORSELED BONE-GRAFTS

The resutls of eighteen acetabular reconstructions in which a bipolar prosthesis and morseled bone grafts were used for a major acetabular defect were evaluated. Thirteen Type-II (cavitary) and five Type-III (combined) acetabular deficits were treated. All of the patients were followed for at least two years. The procedure failed in eleven patients: six had radiographic evidence of complete resorption of the bone grafts and migration of the acetabular component; three, deep infection; one, recurrent dislocation; and one, pain of undetermined cause despite a satisfactory radiographic appearance of the hip. The remaining seven patients had a satisfactory clinical outcome. However, an improved acetabular bone structure, as judged by radiographic evidence of incorporation of the bone grafts, was maintained in only four patients. In our experience, acetabular reconstruction with morseled bone grafts and a bipolar prosthesis was associated with a high rate of failure, and we do not recommend that it be performed routinely. It should be considered only as a salvage procedure in elderly or infirm patients, as a possible alternative to more extensive procedures.