Short-Term Outcome of Shelf-Autograft in Uncemented Total Hip Arthroplasty

Management of acetabular bone defects, especially massive ones, is a challenging issue for surgeons during total hip arthroplasty (THA). Inadequate bone coverage can lead to weakness of acetabular component fixation and instability, and finally, failure of surgery. In recent decades, different techniques and methods have been reported in literature to manage these defects according to their size and location. However, the routine use of many of these new methods is impossible in the majority of patients because of existing financial limitations. The aim of the present study was to evaluate the clinical and radiographic outcomes of THA with acetabular defect reconstruction using shelf-autograft.

This study was designed and conducted in two phases of retrospective and prospective. Between 2012 and 2017, 423 THA surgeries were performed in two hospitals by senior surgeon. A total of 38 THA procedures using shelf autograft were performed. The short-term clinical and radiological results were evaluated in the present study.

The mean coverage angle by graft was 45.5 ± 7.3% (range: 33 - 72%) and horizontal coverage percentage by graft was 79.3 ± 12.8% (range: 54 - 100%). After a mean follow-up of 26 months (range: 12 - 56 months), no evidence of instability was found in any of these hips. Considering loosening and revision as an end-point, the survival rate was 100%. The patients’ mean Harris hip score (HHS) improved from a mean of 35.50 ± 9.11 preoperatively to 95.10 ± 4.71 at the last follow-up. Rigid fixation of graft to host bone, medial insertion of acetabular cementless cup, and avoidance of lateral or high hip center were found to result in excellent THA with shelf graft outcomes.

Despite the development of more advanced methods to manage acetabular defects during total hip replacement, using shelf-graft is a valuable and accessible strategy for hip surgeons, and by the use of suitable techniques, we can expect excellent outcomes even in massive defects