JOA - 2026-03-18 - Journal Article
The 10- to 23-Year Outcomes of Cemented Total Hip Arthroplasty Utilizing Impaction Bone Grafting for Severe Acetabular Bone Defects in Osteoarthritis and Rheumatoid Arthritis.
Hashimoto K, Nakamura Y, Otsuka H, Takahashi N, Morishima T
Topics
Key Takeaway
Cemented THA with impaction bone grafting for severe acetabular defects achieved 100% survivorship free of aseptic loosening at 10 and 15 years, with zero cup revisions for loosening at mean 12.8-year follow-up in 102 hips.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective study evaluated primary cemented THA with impaction bone grafting (IBG) and metal-mesh containment for severe acetabular defects in OA and RA patients at a single Japanese center (2000–2015). JOA hip scores improved ≥20 points in all hips, no component demonstrated aseptic loosening or migration ≥4 mm, and trabecular continuity was present in ≥2 zones in 96% of hips at final follow-up. Kaplan-Meier survivorship using aseptic loosening as endpoint was 100% at both 10 and 15 years, with one revision performed for deep infection only.
Key Limitation
Only 14 hips reached ≥20-year follow-up, making survivorship estimates beyond 15 years statistically underpowered and potentially unreliable for detecting late aseptic loosening.
Original Abstract
BACKGROUND
Long-term outcomes of impaction bone grafting (IBG) with a cemented cup in primary total hip arthroplasty (THA), particularly in Asian populations who have prevalent developmental dysplasia of the hip (DDH), remain limited. We evaluated outcomes at ≥ 10 years after primary cemented THA using IBG for severe acetabular defects in osteoarthritis (OA) or rheumatoid arthritis (RA).
METHODS
We retrospectively reviewed consecutive primary cemented THAs with IBG and metal-mesh containment (2000 to 2015). The cohort comprised 102 hips (99 patients). Clinical outcomes used the Japanese Orthopaedic Association (JOA) hip score. Radiographs assessed component position, maximum acetabular defect distance, horizontal graft coverage, graft incorporation, and loosening. Kaplan-Meier survivorship used aseptic loosening as the endpoint. The mean follow-up was 12.8 years (range, zero to 23); 66 hips had a follow-up of ≥ 10 years, 33 had ≥ 15 years, and 14 had ≥ 20 years.
RESULTS
In all assessed hips, the JOA hip score improved by ≥ 20 points. No acetabular component showed aseptic loosening or migration ≥ 4 mm. The hip center was restored to a mean of 19.1 mm above the teardrop line, and trabecular continuity between host and graft bone was present in ≥ two zones in 96% at final follow-up. Survivorship was 100% at 10 and 15 years. There was one hip that underwent acetabular revision for deep infection; no cup revisions were performed for aseptic loosening.
CONCLUSION
An IBG with a cemented cup provided durable fixation and reliable incorporation in complex primary acetabular defects, with no aseptic loosening observed up to 23 years in this Japanese cohort.