Intraosseous structural graft technique: a new surgical concept in the treatment of superolateral defects in case of dysplastic acetabulum, during hip replacement surgery biomechanical and cadaver experimentations

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Abstract
Purpose The replacement of the dysplastic hip, despite the numerous available surgical techniques, is not entirely solved. One of the reasons for this is the relative lack of bone in the acetabulum. In this study, we present a new concept (intraosseous structural graft technique), with the aim to improve the primary stability and biological environment of the graft. Methods During the procedure in the cranial quadrant of the acetabulum, a proximally hinged cortico-spongious plate is fashioned that is opened laterally and a wedge-shaped graft made from the femoral head is impacted. The precisely fitted graft has good primary rotational and cranial stability which is further improved by a bicortical screw. Results The hypothesis is supported by examination on 3D models. Cadaver experimentations were performed on 19 hips of 10 cadavers, and stability testing was done on a further 20 hips of 10 cadavers with a material testing apparatus. Also the analysis of the biological and mechanical properties of the graft and the implant were examined. Conclusion Based on our results, it can be concluded that our technique provides good primary stability with a more favorable biological condition for bony incorporation compared to other bulk bone graft techniques.

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