Editorial on “Bone remodeling in acetabular reconstruction using a Kerboull-Type reinforcement device and structural bone-grafting in total hip arthroplasty”
Editorial

Editorial on “Bone remodeling in acetabular reconstruction using a Kerboull-Type reinforcement device and structural bone-grafting in total hip arthroplasty”

Toshiki Iwase

Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan

Correspondence to: Toshiki Iwase. Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan. Email: tossy.iwase@gmail.com.

Provenance: This is a Guest Editorial commissioned by the Executive Editor, Dongquan Shi, MD, PhD (Department of Sports Medicine and Adult Reconstruction, Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China).

Comment on: 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.


Received: 08 July 2017; Accepted: 10 July 2017; Published: 14 August 2017.

doi: 10.21037/aoj.2017.07.06


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.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. 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]
  2. 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]
doi: 10.21037/aoj.2017.07.06
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”. Annals of Joint 2017;2:49.

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