Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective
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(2020) 21:581
RESEARCH ARTICLE
Open Access
Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique Basilio De la Torre-Escuredo1,2,3*, Eva Gómez-García1, Salvador Álvarez-Villar1, Julia Bujan3,4 and Miguel A. Ortega3,4
Abstract Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail. Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication. Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock. Keywords: Bone impaction grafting, Trabecular metal augments, Large acetabular defects, Young revision patients
Background Acetabular revision surgery for large defects is a challenge for orthopaedic surgeons. This challenge is greater when these defects occur in young patients, in whom it is essential to restore the centre of rotation of the hip, achieve stable implant fixation, and restore the acetabular integrity and the bone remnant. Several treatment options have been described to achieve this end, with different results [1–6]. The only option that can restore bone remnant is bone allograft * Correspondence: [email protected] 1 Service of Traumatology of University Hospital Ramón y Cajal, Madrid, Spain 2 Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain Full list of author information is available at the end of the article
reconstruction. This allograft may be in structural form, with uncertain results in the literature [4, 7], or in the form of an impacted graft [8], a technique developed by the Nijmegen group [9]. Results with the latter type of reconstruction are good and reproducible in small defects, i.e., cavitary defects or segmental defects affecting less than 50% of the acetabular cavity [10, 11]. However, when the defect affects more than 50% of the acetabular cavity, the results are discouraging [12–14]. For this reason, we have proposed using trabecular metal (TM) augments in combination with bone impaction grafting to aid in the reconstruction of large bone defects. The high porosity of this material and its high coefficient of friction provide good mechanical stability [15].
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