Editorial on “Bone remodeling in acetabular reconstruction using a Kerboull-Type reinforcement device and structural bone-grafting in total hip arthroplasty”
The article entitled “Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty” (1) was reviewed in detail. In primary or revision total hip arthroplasty, acetabular bone loss is one of the challenging conditions to place the acetabular component at the original acetabular region. Although recent advance of ultra-porous coated metal acetabular shell or augment implants may influence the surgeons’ decision making at the time of pre-operative planning for such technically demanding conditions, we have to recognize that the most important concept of total hip arthroplasty is to place the hip rotation center at around the anatomical position with preserving the bone stock of the hip joint.
The authors emphasized that the Kerboull-Type acetabular reinforcement device can guide the surgeons to achieve this concept correctly with protecting the grafted bone from the post-operative over load, and this provides high rate of grafted bone remodeling even in revision setting with using structural allograft.
The authors also described the surgical techniques in detail, and the readers can imagine the precise procedures. The summaries of operative key points are placing the hook of the Kerboull-Type acetabular reinforcement device under the obturator foramen precisely without the horizontal or the vertical plate contacting the acetabular floor, and using the structural graft especially at the weight bearing zone.
In terms remodeling of the grafted bone, the authors acknowledged that tightly packed morselized bone such as used in “impaction bone grafting” technique might have some advantage compared to the structural allograft. Several reports showed “impaction bone grafting” provides good bone stock recovery and good long-term results in primary and revision THAs. However, as we have previously reported (2), especially for very massive bone defect conditions of the maximum acetabular defect distance of ≥20 mm, or of complexed wall defects, “impaction bone grafting” may compromise the mechanical stability of the reconstructed cemented cup-graft complex.
As the authors concluded, the Kerboull-Type acetabular reinforcement device with structural graft and cemented cup is one of the useful options especially for massive acetabular defect conditions, and we convince that every hip revision surgeons should eager to master this technic in detail.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was commissioned and reviewed by the Executive Editor-in-Chief, Dongquan Shi, MD, PhD (Department of Sports Medicine and Adult Reconstruction, Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China).
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/aoj.2017.07.06). The author has no conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Oe K, Iida H, Tsuda K, et al. Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty. J Arthroplasty 2017;32:908-14. [Crossref] [PubMed]
- Iwase T, Ito T, Morita D. Massive bon compromises postoperative cup survivorship of acetabular revision hip arthroplasty with impaction bone grafting. J Arthroplasty 2014;29:2424-9. [Crossref] [PubMed]
Cite this article as: Iwase T. Editorial on “Bone remodeling in acetabular reconstruction using a Kerboull-Type reinforcement device and structural bone-grafting in total hip arthroplasty”. Ann Joint 2017;2:49.
