Hip Pelvis.  2018 Sep;30(3):182-189. 10.5371/hp.2018.30.3.182.

Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients

• Garala K
• Boutefnouchet T
• Amblawaner K
• Chahal G
• Lawrence T

• KMID: 2419514
• DOI: http://doi.org/10.5371/hp.2018.30.3.182

Abstract

PURPOSE
Long-term fixation of cemented acetabular components can be problematic in younger active patients. Our technique is put forward to improve outcomes and maximize implant survivorship in this particular patient population.
MATERIALS AND METHODS
We report on a cohort of young adult patients (less than 55 years old) with cemented total hip replacement (THR) using a novel technique in preparing and cementing the acetabulum with a minimum follow-up of 10 years (mean follow-up, 14 years). Retrospectively collected data on clinical and radiological outcomes were reviewed.
RESULTS
Sixty-five THRs were performed with the minimum study follow-up period. Average age for patients was 44 years old (range, 19-55 years). The mean Hip Disability and Osteoarthritis Outcome Score for patients at final appointment was 92.7. Radiographs taken at an average of 14 years after operation showed 63 of 65 hips showed no evidence of any radiological loosening. Cup survivorship was 100% at the end of the study period.
CONCLUSION
Our technique of preparing the acetabulum in combination with cement fixation is reproducible with excellent results in a cohort of patients prone to early aseptic loosening of the acetabular component.

Keyword

Hip replacement arthroplasty; Cemented acetabular fixation; Subchondral bone plate; Decortication; Implant survival

MeSH Terms

Acetabulum*
Arthroplasty, Replacement, Hip*
Cohort Studies
Follow-Up Studies
Hip
Humans
Osteoarthritis
Retrospective Studies
Survival Rate
Young Adult

Figure

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  Fig. 1 The true floor of the acetabulum is 1st exposed with a gouge osteotome.

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  Fig. 2 The floor is fully exposed with a reamer.

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  Fig. 3 The subchondral bone is prepared with a 6-mm drill to begin to expose the bone under the subchondral sclerotic plate.

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  Fig. 4 The subchondral bone plate is further exposed by skimming the top layer of sclerotic bone off with the gouge osteotome.

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  Fig. 5 A figure of the finished acetabular preparation, just prior to cementation.

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  Fig. 6 Post-operative radiographs of four patients having gone total hip replacement with subchondral bone decortication. (A) Sixteen years and (B, C) seventeen years after operaion.

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  Fig. 7 Pie charts showing responses to satisfaction questionnaires post hip replacement at the latest follow-up for each question (mean 14 years).

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