The Use of Femoral Head Autograft for Acetabular Bone Defect Reconstruction in Total Hip Arthroplasty: A Case Report

Abstract

Aims: This case report presents acetabular bone defect reconstruction using a structural femoral head autograft during primary total hip arthroplasty (THA) for advanced avascular necrosis (AVN) with secondary osteoarthritis. Presentation of Case: A 58-year-old woman presented with six months of right hip pain and progressive difficulty walking for two and a half months. Plain radiographs demonstrated femoral head collapse, joint-space narrowing, subchondral sclerosis and secondary osteoarthritic change, consistent with advanced AVN. She underwent cementless THA. A superolateral acetabular bone defect was reconstructed using a structural autograft fashioned from the resected femoral head. During femoral preparation, an intraoperative oblique middle-femur periprosthetic fracture, most consistent with a Vancouver B1-type pattern after confirmation of final stem stability, was managed using an 11-hole broad plate and two cerclage wires. Discussion: Femoral head autograft is a biologically compatible and cost-conscious option that can provide structural support while preserving acetabular bone stock. In this patient, graft preparation, screw fixation, press-fit cementless cup placement and simultaneous stabilisation of the femoral fracture produced acceptable immediate implant stability. Interpretation of this case is limited by the absence of medium- or long-term follow-up data on graft incorporation, fracture union, component migration and validated functional outcomes. Conclusion: In a complex primary THA for advanced AVN with acetabular bone deficiency, the resected femoral head may be used as a feasible structural autograft. This single case supports technical feasibility rather than definitive effectiveness, and longer follow-up is required to assess durability.