ACETABULAR RECONSTRUCTION WITH ALLOGRAFTS, METALLIC ARMATURE AND CEMENTED PROSTHESIS TECHNIQUE AND LONG TERM OUTCOME M. Kerboull M. Hamadouche L. Kerboull

McKee-Merle d’Aubigné prosthesis métal-métal 1965-1970 ACETABULAR LOOSENING At 2 y. 10 % At 10 y. 32 %

DUP. 13/01/70

Bony reconstruction with bone was absolutely necessary 1974

COCHIN BONE BANK 1955 : PRESERVATION OF MASSIVE BONES (fémur, tibia, humérus) used for bone reconstruction in tumor surgery 1974 : PRESERVATION OF FEMORAL HEADS 1985 : PRESERVATION OF MASSIVE BONES sterilized by gamma radiation ---> Every year 350 femoral heads 80 massive bones

12.73 ITI. 01.74

FIRST ARMATURE 1976 UNIQUE SYMMETRICAL

PRE-OP GIL. 8 m PO

1984 asymmetrical, multiple

Guide and metallic reinforcement for bony reconstruction ACETABULAR ARMATURE Guide and metallic reinforcement for bony reconstruction

ACETABULAR METALLIC ARMATURE HEMISPHERIC CROSS STIFF enough to ensure a strong fixation of a pelvic discontinuity OPEN, flexible enough not to change the elasticity of the acetabulum Automatically provides the artifical hip with the right anatomic centre Partially unloads the grafts during their incorporation

PRINCIPLES OF SURGICAL TECHNIQUE To restore normal anatomic conditions Acetabular cavity of normal size in an anatomic position Choice of the armature

- On a AP x-rays of the hip, the armature appears in a strict lateral view - Obturator hook in close contact with the inferior acetabular margin - Superior screws directed up and back, pass the graft through a reamed hole, bite the sound bone near the sacro iliac joint

SOME EXAMPLES

PRE-OP 1 m PO

PRE-OP 3 y PO

4 m PO PRE OP

1 y PO PRE-OP

GRAFT CONSOLIDATION

PRE-OP 1 m PO

1 y PO 4 y PO

PRE-OP 1 m PO

3 y PO 18 m PO

GRAFT REMODELLING

1 m PO 2 y PO

4 y PO 7 y PO

1 m PO 2 y PO PRE-OP

RADIOLOGICAL PICTURES LONG TERM RADIOLOGICAL PICTURES

PRE-OP 8 y PO

PRE-OP NAU. 1 y PO

6 y PO NAU. 10 y PO

PRE-OP 19 y PO

PRE-OP 20 y PO

1 m PO PRE-OP

10 y PO 18 y PO

PRE-OP 1 m PO 2 y PO

10 y PO 18 y PO

RESULTS

MATERIAL 53 PATIENTS : 48 women, 5 men MEAN AGE : 58 years OPERATED ON FROM 1976 to 1986 60 ACETABULAR RECONSTRUCTIONS CONTINUOUS SERIES ONE SURGEON CHARNLEY-KERBOULL PROSTHESIS

MATERIAL 60 MECHANICAL ACETABULAR LOOSENINGS 4 Double cups 56 THR PREVIOUS THR FAILURES 1 to 3 (near 1.7) 60 MECHANICAL ACETABULAR LOOSENINGS 4 Double cups 56 THR - Métal-Métal : 8 - Métal-Polyethylene : 48

ACETABULAR BONE LOSS CLASSIFICATION AAOS TYPE III 48 TYPE IV 12 SOFCOT TYPE III 48 TYPE IV 12 PAPROSKY TYPE III A 23 TYPE III B 37

FOLLOW-UP Physical and radiologic examination at 6 weeks, 3 months, 6 months, 1 year and every 2 years FOLLOW-UP Entire series 60 12.4 y. (5 to 24) Deceased 8 (10 hips) (4 to 18 y.) Lost 0

COMPLICATIONS 1 trochanteric non union 1 deep veinous thrombosis (DVT) 1 extensive haematoma (debrided) 1 peroneal palsy 0 infection 0 dislocation

CLINICAL RESULTS (D’aubigné score) max 18 GLOBAL FUNCTION BEFORE AFTER 11.7 17.7 EXCELLENT (18) 44 V. GOOD (17) 8 GOOD (16) 1 FAIR (15) 5 POOR (14) 0 BAD (13) 0

RADIOLOGICAL RESULTS SUCCESSES 57 No graft resorption No acetabular loosening FAILURES 3 Graft resorption Acetabular loosening Break of screws or device REVISED : 2

10.86 1 y PO BOT. 10.88 3 y PO

10.93 8 y PO BOT. 10.94 1 y PR

BOT. 10.00 7 y PR

SURVIVAL CURVE (Acetabular component loosening as end point)

CONCLUSION