Total hip arthroplasty for end-stage dysplastic osteoarthritis remains technically demanding because of altered acetabular and femoral anatomy. In 2010, a 59-year-old man with Crowe I dysplasia and Tönnis 3 osteoarthritis underwent total hip arthroplasty using a roof reinforcement ring and cemented polyethylene cup. Because of suboptimal acetabular reaming and insufficient medialisation, a substantial superolateral segment of the ring remained uncovered. This defect was managed with impacted morselized femoral head autograft, and femoral reconstruction was performed with a cementless cone stem. Despite concerns regarding primary mechanical stability, 16-year follow-up showed an asymptomatic and fully functional hip. Radiographs demonstrated graft incorporation, secondary biological stabilisation of the ring, and no evidence of implant instability or loosening. Moderate acetabular wear and mature heterotopic ossification were present. This case highlights that incorporation of morselised femoral head autograft may compensate for insufficient initial host-bone coverage and support durable long-term survival in dysplastic acetabular reconstruction.
Mendes et al. (Tue,) studied this question.