[Reconstruction of the acetabulum after iterative surgery of the hip (report of 38 cases)].

UNLABELLED

The hip revision surgery like oncology surgery may need massive allografts to rebuilt the acetabulum or an hemi pelvis. Since 1982 we have chosen to use deep frozen massive allografts instead of massive metallic prosthesis, resection, or osteosynthesis of the femur to the iliac bone or the sacrum. These last proposal seems for our patients too heavy, the functional results being always bad.

PATIENTS AND METHODS

--37 Acetabulum reconstruction has been performed. (18 hemi-pelvis). --The follow-up is from 1 to 12 years with a medical of 5 years and 2 months. --The tumoral pathology (14 cases) was for 50% chondrosarcomas [7]. 6 infections (1 massive echinococcosis and 5 osteomyelitis) --17 hip reconstruction for revision surgery. We use deep frozen allografts cryopreserved with Dimethylsulfoxide 10%. No secondary irradiation. The allografts were used after securisation (after the 6th month after the procurement). Most for the time we used 2 platres, one posterior outside the pelvis, one anterior inside the pelvis. Screwed on the contralateral pubis bone and the sacrum. A hip prosthesis was used in almost all the cases. In tumoral cases, the results were excellent with chondrosarcomas but in the other cases metastasis and death were usually seen in the 2 or 3 years following the surgery. --3 instability of the prosthesis. --2 fractures of the allograft. In the non tumoral cases, the integration of the graft was excellent. --1 instability of the prosthesis needed a antiluxent crescent. --1 fracture of the graft needed adjonction of autografts and new osteosynthesis. --1 superficial infection. Good functional results has been obtained with the use of massive allografts. The fracture of the allografts can heal without a new operation. In some cases we have had some liquid surrounding the grafts which can be a immunological response.