Is the size of the acetabular bone lesion a predictive factor for failure in revisions of total hip arthroplasty using an impacted allograft?

Objective: The aim of this study was to determine the acetabular bone lesion size (in millimeters) from which impacted bone graft failure starts to occur more frequently, through simple anteroposterior hip radiographs, and whether measurement of the defect on simple radiographs maintains the same pattern in inter and intraobserver assessments.

Methods: Thirty-eight anteroposterior pelvic-view radiographs from patients undergoing revision of an acetabular prosthesis were retrospectively analyzed and assessed. In the vertical plane, the bilacrimal line was measured in millimeters from the farthest point found on the bone edge of the acetabular osteolysis to the top edge of the cementation or of the acetabular implant in uncemented cases. The base was taken to be a line perpendicular to bilacrimal line, with the aim of eliminating any pelvic tilt effects. This measurement was named the vertical size of failure. Radiographs produced four years after the operation were analyzed to investigate any failure of the technique.

Results: The graft failure rate in the study group was 26.3%. The failures occurred in cases with an initial bone defect larger than 11 mm. No cases with measurements smaller than this evolved with failure of the revision. The highest incidence of graft failure occurred in cases described as advanced according to the "Paprosky" classification.

Conclusion: Failure of acetabular revision arthroplasty using an impacted graft did not present any statistically significant correlation with the vertical extent of the lesion on simple anteroposterior radiographs, as a predictor of treatment failure.