Treatment of Acetabular Segmental Deficits (2)

Management of segmental Acetabular deficit

■ If a segmental deficit is limited to the superior or the posterior rim of the acetabulum, a femoral head allograft usually is sufficient. Use bone from an osteoarthritic femoral head. Osteoporotic bone from a patient with a femoral neck fracture is inadequate.

■ With a high-speed burr or matching male and female reamers, prepare the surfaces of the graft and the recipient bed to match or leave the graft slightly larger than the deficit so that an interference fit can be obtained to enhance stability.

■ Use rigid internal fixation to secure the graft to host bone. Most superior segmental deficits have a residual shelf of bone that supports the graft, and lag screws alone are sufficient for fixation (Fig. 3-159; see also Fig. 3-74). Because bony support of posteriorly placed structuralgrafts often is not achieved, fixation with a buttress plate is required.

■ Provisionally fix the graft with Kirschner wires. 

■ Contour a pelvic reconstruction plate along the posterior column, and fix it with multiple screws.

■ After placement of the revision socket, use ancillary screws to fix the implant to host bone. Screws fixing the socket to the bone graft do little to increase the stability of the construct.  

Note: this article comes from CAMPBELL’S OPERATIVE ORTHOPAEDICS by S. Terry Canale James H. Beaty.