The 10- to 23-Year Outcomes of Cemented Total Hip Arthroplasty Utilizing Impaction Bone Grafting for Severe Acetabular Bone Defects in Osteoarthritis and Rheumatoid Arthritis.

Abstract

<h4>Background</h4>Long-term outcomes of impaction bone grafting (IBG) with a cemented cup in primary total hip arthroplasty (THA), particularly in Asian populations who have prevalent developmental dysplasia of the hip (DDH), remain limited. We evaluated outcomes at ≥ 10 years after primary cemented THA using IBG for severe acetabular defects in osteoarthritis (OA) or rheumatoid arthritis (RA).<h4>Methods</h4>We retrospectively reviewed consecutive primary cemented THAs with IBG and metal-mesh containment (2000 to 2015). The cohort comprised 102 hips (99 patients). Clinical outcomes used the Japanese Orthopaedic Association (JOA) hip score. Radiographs assessed component position, maximum acetabular defect distance, horizontal graft coverage, graft incorporation, and loosening. Kaplan-Meier survivorship used aseptic loosening as the endpoint. The mean follow-up was 12.8 years (range, zero to 23); 66 hips had a follow-up of ≥ 10 years, 33 had ≥ 15 years, and 14 had ≥ 20 years.<h4>Results</h4>In all assessed hips, the JOA hip score improved by ≥ 20 points. No acetabular component showed aseptic loosening or migration ≥ 4 mm. The hip center was restored to a mean of 19.1 mm above the teardrop line, and trabecular continuity between host and graft bone was present in ≥ two zones in 96% at final follow-up. Survivorship was 100% at 10 and 15 years. There was one hip that underwent acetabular revision for deep infection; no cup revisions were performed for aseptic loosening.<h4>Conclusion</h4>An IBG with a cemented cup provided durable fixation and reliable incorporation in complex primary acetabular defects, with no aseptic loosening observed up to 23 years in this Japanese cohort.