1164THE JOURNAL OF BONE AND JOINT SURGERY
Acetabular bone reconstruction in revision
A COMPARISON OF FREEZE-DRIED, IRRADIATED AND
CHEMICALLY-TREATED ALLOGRAFT VITALISED WITH
AUTOLOGOUS MARROW VERSUS FROZEN NON-IRRADIATED
B. G. Ochs,
From University of
? B. G. Ochs, MD, Orthopaedic
? J. Rieth, Medical Student
? A. Ateschrang, MD, General
? K. Weise, MD, Professor,
? U. Ochs, MD, Consultant
BG Trauma Centre
University of Tuebingen,
72076 Tuebingen, Germany.
? U. Schmid, MD, Orthopaedic
Department for Hand Surgery
Vulpius Clinic, Vulpiustrasse 94,
74906 Bad Rappenau,
Correspondence should be sent
to Dr B. G. Ochs; e-mail:
©2008 British Editorial Society
of Bone and Joint Surgery
J Bone Joint Surg [Br]
Received 2 November 2007;
Accepted after revision 18 April
Deficiencies of acetabular bone stock at revision hip replacement were reconstructed with
two different types of allograft using impaction bone grafting and a Burch-Schneider
reinforcement ring. We compared a standard frozen non-irradiated bone bank allograft
(group A) with a freeze-dried irradiated bone allograft, vitalised with autologous marrow
(group B). We studied 78 patients (79 hips), of whom 87% (69 hips) had type III acetabular
defects according to the American Academy of Orthopaedic Surgeons classification at a
mean of 31.4 months (14 to 51) after surgery. At the latest follow-up, the mean Harris hip
score was 69.9 points (13.5 to 97.1) in group A and 71.0 points (11.5 to 96.5) in group B. Each
hip showed evidence of trabeculation and incorporation of the allograft with no acetabular
These results suggest that the use of an acetabular reinforcement ring and a living
composite of sterile allograft and autologous marrow appears to be a method of
reconstructing acetabular deficiencies which gives comparable results to current forms of
Primary total hip replacement is being under-
taken in patients who are younger, living lon-
ger and have higher demands. There is also a
real risk that they will need two or more revi-
sion procedures in their lifetime.
Substantial bone loss, especially of pelvic
bone, is one of the most challenging problems
faced by the surgeon who performs revision sur-
gery.1-4 Restoration of bone stock is required to
stabilise the components and facilitates further
revision.5 The selection of suitable bone graft is
based on the size of the defect, its location, the
biology of the defect site, and whether structural
support is required.6 The use of impaction bone
grafting is well established. High rates of success
have been reported when morcellised graft is
used in combination with uncemented,7-9 and
cemented acetabular components,10-13 or with14-
18 or without10-13 a reinforcement ring.14-18
Autograft has been shown to be better than
allograft in restoring bone stock because of its
osteoconductive, osteoinductive and osteo-
autograft is of poorer quality in elderly
patients and postmenopausal women, allograft
is used extensively not least because of its
ready availability and lack of donor site mor-
bidity.21-23 However, allograft does have a
number of disadvantages. There is a risk of
transmitting pathogens,24,25 and of an adverse
immune response.26,27 In addition, the method
of processing, preservation, sterilisation and
storing of allograft bone may influence its bio-
physical properties.28-31 Hence, morcellised
allograft, albeit commonly used, serves mainly
as an osteoconductive matrix because of its
lack of osteogenic cells and reduced osteo-
The safety of allograft therefore remains a
major concern. The European Union has
issued standards to maximise the quality and
safety of allograft,32,33 but these have created
difficulties in bone bank management and
insurance that have yet to be resolved.
This study was undertaken to evaluate the
clinical and radiological results of using a safe,
freeze-dried, irradiated allograft-autologous
marrow composite with a Burch-Schneider
reinforcement ring (Zimmer GmbH, Munsin-
gen, Switzerland) to manage severe acetabular
deficiency in revision hip replacement. We used
a matched cohort of patients in which frozen
non-irradiated bone graft had been used as a
Patients and Methods
Between 1 January 2003 and 31 December
2005, 103 patients (104 hips) were treated for
aseptic loosening of the acetabular component
with an associated bony defect. Patients were
ACETABULAR BONE RECONSTRUCTION IN REVISION ARTHROPLASTY1171
VOL. 90-B, No. 9, SEPTEMBER 2008
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