Autogenous bone grafts from the femoral head for the treatment of acetabular deficiency in primary total hip arthroplasty with cement. Long-term results.

Thirty-five consecutive total hip arthroplasties in twenty-eight patients were performed with use of cement and insertion of an autogenous graft from the femoral head. Five patients (six hips) subsequently died or were lost to follow-up. The results for the remaining twenty-three patients (twenty-nine hips) were reviewed retrospectively at a mean of eleven years (range, seven to seventeen years) after the operation. All of the grafts united. The mean estimated coverage of the acetabular component by the autogenous graft was 27 per cent (range, 15 to 45 per cent). Three sockets (10 per cent) were revised because of symptomatic loosening without infection at a mean of ten years (eight, ten, and twelve years) after the index procedure. All three hips were found to have viable, bleeding bone in the region of the remaining graft. An additional eight acetabular components had a nonprogressive, asymptomatic, continuous radiolucent line at the cement-bone interface. This finding was assumed to indicate loosening of the socket, so the total prevalence of loosening was 38 per cent (eleven of twenty-nine sockets). There was no significant difference between the loose and the well fixed components in terms of the amount of coverage by the graft (p > 0.2) or the method of fixation (p > 0.4). There was no collapse or resorption of the graft that was of mechanical consequence. Autogenous femoral-head bone-grafting is a useful technique with a good potential for long-term success when the amount of coverage by the graft is limited to less than 40 per cent of the surface of the acetabular component.