Biologic Treatment Options for the Hip: A Narrative Review

H. Thomas Temple, MD

Disclosures

Curr Orthop Pract. 2019;30(6):501-509. 

In This Article

Abstract and Introduction

Abstract

The goal of surgery around the hip is to preserve both acetabular and femoral bone stock and to optimize function, specifically abductor function. Biologic options include allografts, allograft metal composites, and structural grafts that over time incorporate, are durable, and provide bone stock for future reconstruction(s). Reconstructive principles are guided by the defect(s) after tumor surgery, patient factors (age, chemotherapy, comorbid conditions), and graft availability. The challenges of reconstruction around the hip are stability of the joint and optimizing abductor function. For routine reconstructions around the hip for osteoarthritis and low-energy trauma, metal implants, either arthroplasty or internal fixation, are employed with high rates of success. Biologic implants are generally reserved for revision and oncologic surgery when large structural bone and soft-tissue defects are present. Structural allografts are used for both acetabular and femoral defects to replace bone and or conserve bone stock in anticipation of future reconstructions. Maintaining soft-tissue attachments and optimizing tension in the hip abductors also is an important consideration in optimizing function, especially in younger patients. Biologic options are also important in patients with prior arthroplasty who sustain periprosthetic fractures or develop tumors above or below existing constructs that require excision and reconstruction. Complications are common both early and late postoperatively. For this reason, patients must be apprised of the risks, and surgeons should be poised to take appropriate steps to mitigate and/or treat potential complications and to anticipate future reconstructions to preserve and enhance function.

Introduction

Biologic repair around the hip generally involves structural augmentation or replacement of defects in the acetabulum and proximal femur. These defectsmay arise from trauma, infection, tumors, or aseptic loosening. Periprosthetic fractures, infection, and aseptic loosening are common conditions that require biologic repair or replacement, whereas tumors, especially primary tumors of bone, are rare.

Structural acetabular grafts are used to augment closed defects that may result from advanced avascular necrosis, inflammatory arthritis, periprosthetic infections, or aseptic implant loosening. Large structural or open acetabular defects require structural allografts, with or without metal augments, custom implants, or osteoarticular allografts.

In the proximal femur, large femoral or tibial struts often are used alone or to supplement internal fixation after periprosthetic femoral fracture. Structural grafts generally are used as composites with hip implants to replace large segments of bone. Osteoarticular grafts are used sparingly and most commonly in young children with open physes. In rare cases, tumors can involve both the acetabulum and femur. In these instances, pelvic and proximal femoral allografts along with a bipolar or total hip arthroplasty are used.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....