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

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

3. DUP.
13/01/70

4. Bony reconstruction with bone was absolutely necessary
1974

5. 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

6. 12.73
ITI.
01.74

7. FIRST ARMATURE
1976
UNIQUE
SYMMETRICAL

9. PRE-OP
GIL.
8 m PO

10. 1984 asymmetrical, multiple

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

14. 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

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

21. - 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

23. SOME EXAMPLES

24. PRE-OP
1 m PO

25. PRE-OP
3 y PO

26. 4 m PO
PRE OP

27. 1 y PO
PRE-OP

28. GRAFT CONSOLIDATION

29. PRE-OP
1 m PO

30. 1 y PO
4 y PO

31. PRE-OP
1 m PO

32. 3 y PO
18 m PO

33. GRAFT REMODELLING

34. 1 m PO
2 y PO

35. 4 y PO
7 y PO

36. 1 m PO
2 y PO
PRE-OP

37. RADIOLOGICAL PICTURES
LONG TERM
RADIOLOGICAL PICTURES

38. PRE-OP
8 y PO

39. PRE-OP
NAU.
1 y PO

40. 6 y PO
NAU.
10 y PO

41. PRE-OP
19 y PO

42. PRE-OP
20 y PO

43. 1 m PO
PRE-OP

44. 10 y PO
18 y PO

45. PRE-OP
1 m PO
2 y PO

46. 10 y PO
18 y PO

47. RESULTS

49. 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

50. 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

51. 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

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

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

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

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

56. y PO
BOT.
y PO

57. y PO
BOT.
y PR

58. BOT.
y PR

59. SURVIVAL CURVE (Acetabular component loosening as end point)

60. CONCLUSION