Total Hip Arthroplasty with Bulk Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip

Developmental hip dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Autogenous bulk grafting using the femoral head has been utilised to achieve anatomic cup placement and superolateral bone coverage in these patients, but reported outcomes on this technique have been mixed with the lack of graft integration and subsequent collapse, an early cause of failures. We describe a novel technique combining the use of bulk autograft with an iliac osteotomy, which provides primary stability and direct cancellous-cancellous bone contact, optimising the environment for early osseointegration. Twenty-one hips in 21 patients with DDH underwent this technique and were followed for a mean of 8.1 years. The preoperative radiographic classification was Crowe type I in 12 hips (57%), type II in 4 hips, and type III in 5 hips, and the mean Sharp angle was 49.6° (range 42°–60°). All grafts united by year. At time of followup, there was no radiographic evidence of graft collapse or loosening. There were no reoperations. Our study has shown that this technique variation combining an iliac osteotomy with bulk autograft in cases of developmental hip dysplasia provides early stability and reliable graft incorporation, together with satisfactory clinical and radiological outcomes in the medium term. Longer term study is necessary to confirm the clinical success of this procedure. 1. Introduction Developmental hip dysplasia (DDH) presents considerable technical challenges to the primary arthroplasty surgeon. Achieving correct positioning of the acetabular component and adequate bone coverage can be difficult. Harris first described the technique of bulk autogenous grafting to achieve superolateral bone coverage in 1977, and while early-to-midterm results were promising [1], longer term outcomes have been mixed. In Harris’s series, 21% of patients had radiographic evidence of loosening at seven years [2], and outcomes at mean sixteen years showed a high rate of acetabular failure due to component loosening and graft collapse [3]. Recently, however, more favourable long-term outcomes have been reported in DDH patients utilizing bulk autografts with both cemented [4–6] and uncemented [7] implants. Achieving union and stability of the autogenous graft have been identified as key determinants of a successful outcome with this technique [8]. Bulk autogenous grafts are known to incorporate slowly and often incompletely, [9] limiting their ability to respond to stresses under cyclic loading. The main factors affecting incorporation of the