The Exeter method-acetabular impaction grafting with cemented reimplantation.

OBJECTIVE: Restoration of acetabular anatomy and biomechanics at revision hip surgery by replacing deficient acetabular bone through impaction of allograft and/or autograft bone chips.

INDICATIONS: Aseptic loosening of the socket due to osteolysis, bone loss from infection, iatrogenic bone loss due to implant removal, and in the primary setting protrusio acetabuli, dysplasia and previous acetabular fracture.

CONTRAINDICATIONS: Large segmental peripheral acetabular defects which cannot be contained, the presence of untreated infection, unstable acetabular fractures, previous radiotherapy to the affected hip area.

SURGICAL TECHNIQUE: Sound exposure of the acetabulum with delineation of the bony defect. Creation of a host environment suitable for bone graft and containment of segmental defects using rim mesh or porous augments. Impaction grafting using layered allograft or autograft bone chips of 0.8-1 cm(3), packed using hemispherical impactors, followed by cementing of a polyethylene acetabular component with pressurisation.

POSTOPERATIVE MANAGEMENT: Partial weight bearing 6 weeks, modified depending on level of containment and intra-operative findings.

RESULTS: A successful and reproducible technique with survival up to 87 % at 20 years for aseptic loosening in the revision setting.