Bone healing of severe acetabular defects after revision arthroplasty: A clinical positron emission tomography study of 7 cases

Background and purpose Healing of acetabular bone grafts may be difficult to assess in conventional radiographs. We used PET to analyze healing of morselized bone allografts, impacted in large osteolytic acetabular defects at revision arthroplasty. Patients and methods 7 cases had a cup revision because of loosening, with repair of a segmental defect using a perforated, wide and thin plate. The osteolytic acetabulum was impacted with morselized bone allograft before cementing a polyethylene cup. [(18)F]-fluoride PET scans were used to monitor bone healing inside the graft bed 1 week, 4 weeks, and 12 months after surgery. The contralateral pelvic bone above the acetabulum was used as reference. A second group of 4 cases was analyzed for bone-forming activity in the state of mechanical loosening of an acetabular component of a THA. Results Preoperatively, the uptake was raised by 64% compared to the reference. 1 week after surgery it was increased by 77% in segmental regions, while the uptake was at the reference level in cavitary regions. After 4 months the uptake was increased by 91% in cavitary regions and by 117% in segmental regions. 1 year after surgery, the increase in uptake was 20% in both regions. All implants were stable on radiographs. InterpretationWe found PET to be a sensitive and useful method for evaluation of the spatial and temporal development of bone formation.