Total hip arthroplasty with shelf grafts using uncemented cups. A long-term follow-up study.

A series of 33 hips treated with cementless cups and structural autograft or allograft were reviewed at a minimum follow-up period of 5 years. Seventeen hips received a shelf autograft during primary hip arthroplasty and 16 received an allograft at revision. In the hips receiving autografts, the average preoperative hip score was 45.1 and the score at final review was 87.5, whereas in the revisions reconstructed with allografts, the average preoperative hip score was 44.4 and the score at final review was 82. Overall, only 2 of 33 hips were considered failures, giving a success rate of 94% at an average follow-up period of 6.6 years. Leg-length discrepancy greater than 2 cm was seen in 27 of 33 hips, and at final review only 4 of 33 hips had a leg-length discrepancy greater than 2 cm. All grafts united to host-bone. Resorption, when seen, was minor, with only three grafts showing moderate resorption. Our data support the use of cementless cups with structural allografts and autografts, provided the graft supports less than 50% of the cup.