The Journal of Arthroplasty Vol. 11 No. 1 1996 Total Hip Arthroplasty With Shelf Grafts Using Uncemented Cups A Long-term Follow-up Study Elsayed Morsi, MBBCH, MS(Orth), Don Garbuz, MD, and Allan E. Gross, MD Abstract: A series of 33 hips treated with cementless cups and structural auto- graft or allograft were reviewed at a minimum follow-up period of 5 years. Seven- teen hips received a shelf autograft during primary hip arthroplasty and 16 received an allograft at revision. In the hips receiving autografts, the average pre- operative hip score was 45.1 and the score at final review was 87.5, whereas in the revisions reconstructed with allografts, the average preoperative hip score was 44.4 and the score at final review was 82. Overall, only 2 of 33 hips were consid- ered failures, giving a success rate of 94% at an average follow-up period of 6.6 years. Leg-length discrepancy greater than 2 cm was seen in 27 of 33 hips, and at final review only 4 of 33 hips had a leg-length discrepancy greater than 2 cm. All grafts united to host-bone. Resorption, when seen, was minor, with only three grafts showing moderate resorption. Our data support the use of cementless cups with structural allografts and autografts, provided the graft supports less than 50% of the cup. Key words: shelf autografts, shelf allografts, cementless cups, leg- length discrepancy. Total hip arthroplasty (THA) in the presence of acetabular deficiency often necessitates bone-graft- ing to obtain support for the cup, to place the cen- ter of the cup anatomically, and to restore bone stock. This situation is seen both in primary arthro- plasty in dysplastic hips and in revision arthro- plasty. Results of cemented acetabular components in conjunction with autograftsk2 and allografts 3,4 have not been encouraging. Indeed, these authors have cautioned against the use of structural grafts, preferring to place the cup at a high hip center.S In recent years, there has been increasing suc- cessful use of cementless components on the acetabular side in both primary 6,7 and revision8, 9 From Mount Sinai Hospital, Toronto, Ontario, Canada. Reprint requests: A. E. Gross, MD, Division of Orthopaedic Surgery, University of Toronto, Mount Sinai Hospital, 600 Uni- versity Avenue, Suite 476, Toronto, Ontario, Canada, MSG 1X5. arthroplasty. Few studies in the literature have addressed the use of bone grafts in combination with cementless cups. Short-term studies of cementless cups and shelf autografts have been encouraging. 10-12 When allografts have been used in combination with cementless cups, results have been mixed. One group reported favorable results (success rate, 96%) at an average follow-up period of 5.1 years,~3, ~4 whereas a second group reported a 44% failure rate at an average follow-up period of 46 months. 15 The purpose of this study is to report our medium-term results (minimum, 5 years; average, 6.6 years) of the use of cementless cups in combi- nation with bulk allografts and autografts. Only patients who had minor column defects were included. These defects involve a loss of part of the rim plus the corresponding acetabular wall, but less than 50% of the acetabulum. ~6 81