CLINICS 2008;64:509-14 CLINICAL SCIENCE ACEt AuLbAr rECoNSuCtrtIoN wIth humAN ANd vIboNE frEEzE- drIEd boNE grAftS ANd A rEINforCEmENt dEvICE Ricardo Rosito,I Carlos Roberto Galia,I,II Carlos Alberto Souza Macedo,I Luis Fernando Moreira,II Lourdes Maria Araújo C. Quaresma,III Humberto Moreira PalmaI doi: 10.1590/S1807-59322008000400016 Rosito R, Galia CR, Macedo CAS, Moreira LF, Quaresma LMAC, Palma HM. Acetabular reconstruction with human and bovine freeze- dried bone graft and reinforcement device. Clinics. 2008;63:509-14. BACKGROUND: This is a cohort trial (1997-2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE: To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS: There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The av- erage follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d’Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn’s et al. criteria for radiographic bone incorporation. RESULTS: No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION: The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty. KEYWORDS: Total Hip Arthroplasty. Revision. Bone grafts. Freeze-dried. Xenografts. Bovine. INTRODUCTION Acetabular bone loss is one of the main problems in revision total hip arthroplasty.1 Treatment of type I and II D’Antonio et al. deficiency1 with impacted cancellous morselized bone has been shown to provide good results.2 However, the treatment of severe type III and IV defects is more challenging. A valuable option in these cases is the use of bulk allografts, but the rate of failure of structural grafts that are not supported by a reinforcement device has been I Orthopedics Department - Tissue Bank - Hospital de Clínicas de Porto Alegre (HCPA) – Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS) – Porto Alegre/RS, Brazil. II Surgery Postgraduate Program – Faculdade de Medicina da Universidade Federal do Rio Grande do Sul – Porto Alegre/RS, Brazil. III Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA) – Brasília/ DF, Brazil. Email: ricardo@rosito.com.br Received for publication on March 26, 2008 Accepted for publication on May 29, 2008 shown to increase over time.3 As an alternative, some authors have advocated the use of an acetabular reinforcement ring instead. This device seems to protect grafts from overstress, helping to settle the reconstructed acetabulum until the graft is integrated.4,5 Unfortunately, choosing the reconstruction technique for an acetabular defect is not the only concern. Bone grafts are also essential, and there are limited quantities of autografts to replace these losses. Moreover, the tissue requirements are far greater than the real availability of allografts.6 This situation led us to search for an alternative method of tissue processing for the disinfection and sterilization of grafts, as well as to attempt to use xenografts from a bovine source. A lyophilization process was developed for these reasons. This study was started after initial confirmation using experimental studies in animals7 and the use of this process in other general orthopedic procedures. Therefore, the aim of this study was to demonstrate the clinical and radiographic bone integration capabilities of human and bovine freeze- 509