Hemispheric hydroxyapatite-coated cups with impacted graft for severe bone defects in acetabular reconstruction: ten year follow-up.

Cementless acetabular reconstruction with bone grafting has been limited to moderate bone defects. We report the outcomes of 57 acetabular revisions in 45 patients with severe bone defects (Paprosky type IIIA) using hemispheric hydroxyapatite (HA)-coated cups and impacted graft. After a mean follow-up of 10 years, all but 2 cups (3.5%) remained radiologically stable. There was clear radiological consolidation and medial wall remodelling of the graft in 62% of the cases. In 2 cases (3.5%), nonprogressive lucencies were found; in 3 cases (5.3%) a medial gap of 2 mm, detected postoperatively, was progressively filled by newly formed bone during follow-up. Mean MDA score rose from 7.3 points preoperatively to 16.8 points in the last evaluation, with an excellent pain relief report. These results suggest that the combined use of HA-coated hemispheric cups with impacted graft to treat Paprosky IIIA defects provides a long-lasting stable implant, restores bone stock, and yields excellent clinical results.