Impaction bone grafting as a method of choice in bone defect management in the revision hip arthroplasty: a cases series

Abstract

Introduction Reconstruction of the acetabulum during revision arthroplasty is a challenging task in the setting of massive bone defects. Often the only effective method is impaction bone grafting (IBG). The purpose is to demonstrate the capabilities of the X-Change impaction bone grafting technology in replacing acetabular defects as a method of choice for revision hip arthroplasty.Materials and methods In the presented series of cases, the use (IBG) turned out to be the method of choice, allowing for high-quality reconstruction. In each presented case, revision hip arthroplasty was performed with augmentation with a reconstructive mesh or trabecular metal augment to create support and contain the defect to retain the osteoplastic material.Results During follow-up periods of 4.8 to 6.5 years there were no signs of resorption or loosening. According to the Harris hip score the results were 96, 97 and 89 points respectively.Discussion Impaction bone grafting technology is quite versatile. It can be used in various coditions of revision arthroplasty with contained defects of the acetabulum. In contrast to the use of modular revision augmentation systems and additive technologies it makes possible to achieve dense filling of the smallest defects and profile a bed congruent with the acetabular component. The use of cemented fixation makes it possible to further stabilize the impacted bone chips and use mechanotransduction mechanisms that  stimulate the bone remodeling. The use of IBG has proven to be an effective technique for the reconstruction of medium-sized acetabular defects in combination with mesh and cement cup, as well as in combination with trabecular metal augments.Conclusion The use of IBG during revision hip arthroplasty can be especially effective for small acetabulum sizes. Combining IBG with trabecular metal augments significantly expands the application of this technology. The use of IBG makes it possible to create a bone reserve, which creates more favorable conditions for inevitable repeated revision interventions.