الفهرس 
The hipboneOnly 14 pages are availabe for public view
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Abstract
The number of hip arthroplasties done every year is rising up, leading to more cases that need revision. One of the main issues in the revision surgery as well as complex primary total hip arthroplasty is acetabular reconstruction. It is mandatory to reconstruct acetabular defects to help the surgeon to reach the main target of this type of surgery; a stable well-positioned construct.
Several classification systems were hypothesized in order to accurately classify these defects and try to make a clear specification for each type of reconstruction techniques reported in the literature. The most common and well-known classification systems are those popularized by Paprosky et al and AAOS systems.
Biologic method was introduced with tightly impacted cancellous bone grafts for acetabular reconstruction, to restore acetabular bone stock, to restore normal hip biomechanics, and to allow for further revision if needed.
This was one of the main reasons to start this thesis in Menoufia University Hospitals trying to find an effective solution for reconstruction of the acetabular defects in the complex primary and difficult revision cases referred to our hospital.
This study started in 2020 to report the clinical and radiological outcome of using impaction bone graft in hip arthroplasty for fifty hips that had an acetabular defect.
Fifty patients were followed up for a mean of 23 months after the surgery. Both clinical and radiological evaluation for these cases were done. Clinical evaluation including HHS and Patient Satisfaction Score preoperatively and at the latest follow up were done. Radiological assessment for the IBG incorporation and whole construct utilized by applying the method of Burssens et al criteria, trabecular bridging be identified between the host bone and IBG as described by Conn et al.
Preoperative planning in acetabular reconstruction represents the corner stone in the success of this type of surgery. In revision cases, patients should be notified with the expected time to return to their activities and the possibility of complications.
In this study, we used IBG for fourteen patients in addition to a primary prosthesis. Patients were divided in two halves, sixteen of them had cemented cups and the other thirty-four had cementless components.
This study includes four cases that were had history with infection preoperatively. According to the protocol of management of infected cases, they had two stage revision surgery and Impaction bone grafting was used in the second stage of revision.
Twenty cases of the revision group needed trochanteric osteotomy for the femoral side, Reattachment was done in all cases using soft wires.
All cases had succeeded clinical scores postoperatively with eight poor results, thirty fair results and twelve good results according to HHS grading. Forty-eight of the patients were satisfied with the overall procedure.
Full weight bearing started at 1.5 months in cases without trochanteric osteotomy. It was postponed to 3 months for cases that had trochanteric osteotomy.
There were significant relationships between the type of graft, the type of fixation, the defect size and thickness of graft layer and the IBG incorporation to host bone There was one case of iatrogenic acetabulum defect treated immediately by conversion of cup to augmented dual mobility cup with flanges fixed by screws. Later on the follow up showed loosening of screws but the cup remained stable till the latest follow up with no need for revision. One case of greater troch. Fracture and other with perforation of medial acetabular wall but there was no affection of cup stability. No cases of reinfection were reported, and no revisions were done.
There were two cases with radiolucent line more than 2 mm appear at follow up period, but the cups were stable and no revision was needed, The acetabular cup constructs of all patients remain stable with no signs of migration in follow up x rays through the follow up period and no signs of femoral subsidence of stems also.