Mid- to long-term outcomes and survival of total hip arthroplasty using a Kerboull-type acetabular reinforcement plate: an analysis of associated factors

INTRODUCTION: Revision total hip arthroplasty (THA) for acetabular bone loss is challenging. The modified Kerboull-type (KT) plate has been adopted; nonetheless, mid- to long-term clinical outcomes remain poorly understood. We evaluated survival rates and radiographic outcomes of acetabular reconstruction using the KT plate and investigated risk factors for plate breakage or re-revision. MATERIALS AND METHODS: We retrospectively included 120 patients (130 hips) who underwent acetabular reconstruction using the KT plate (1997-2024) and evaluated perioperative outcomes, Harris Hip Score (HHS), survival rates, and key radiographic parameters. RESULTS: Mean age at surgery and follow-up duration were 69.0 ± 10.4 years and 107.4 ± 71.7 months, respectively. Mean blood loss and operative time were 630.2 mL and 284.3 min, respectively. HHS improved from 56.2 to 86.4. Fractures (5.3%) and dislocations (3.0%) were observed. Ten-year survival rates were 95.6% for re-revision and 93.0% for plate breakage. Failure and head migration occurred in 11 (8.5%) and 6 (4.6%) hips, respectively. Multivariate analysis identified younger age, use of morselized bone chips alone, and postoperative head migration as independent predictors of failure. In revision THA cases with ≥ 5-year follow-up and Paprosky classification type 3 A or 3B defects, age, Knight classification, and head migration differed significantly between hips with and without failure. Hips with plate breakage requiring re-revision showed greater horizontal head migration than those managed nonoperatively. CONCLUSIONS: KT plate-based acetabular reconstruction achieved excellent mid- to long-term outcomes, with a 10-year survival rate exceeding 95% and significant functional improvement. Younger age, bone chip grafting alone, and femoral head migration were associated with failure. Even when plate breakage occurred, re-revision was avoided if bulk bone grafts provided sufficient mechanical support and head migration remained minimal. Surgical outcomes were better in the later period than in the early period due to improved learning, surgical techniques, and grafting strategies.