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Ceddia M, Solarino G, Pulcrano A, Benedetto A, Trentadue B. Finite Element Analysis of a 3D-Printed Acetabular Prosthesis for an Acetabular Defect According to the Paprosky Classification. MATERIALS (BASEL, SWITZERLAND) 2025; 18:1295. [PMID: 40141579 PMCID: PMC11943772 DOI: 10.3390/ma18061295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 03/12/2025] [Accepted: 03/14/2025] [Indexed: 03/28/2025]
Abstract
The treatment of Paprosky Type III acetabular defects is a significant challenge in orthopedic surgery, as standard components often do not fit properly. This study aims to evaluate the biomechanical efficacy of a custom 3D-printed PEEK acetabular prosthesis compared to a conventional titanium implant. A 3D model of the pelvis was created using a computed tomography scanner and a custom-made acetabular implant was designed. Finite element analysis (FEA) was performed using Ansys Workbench to evaluate the stress and strain distribution of two materials on the pelvic bone. The results showed that the titanium prosthesis model had less strain transmitted to the bone, while the PEEK model had better stress transmission and bone stimulation. The use of custom implants reduced the risk of stress shielding, potentially improving long-term bone health. Three-dimensional-printed acetabular prostheses therefore offer significant advantages over traditional implants, suggesting improved implant stability and reduced failure rates.
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Affiliation(s)
- Mario Ceddia
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy;
| | - Giuseppe Solarino
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Alessandro Pulcrano
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Antonella Benedetto
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy;
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Perticarini L, Andriollo L, Rossi SMP, Sangaletti R, Benazzo F. Severe acetabular bone loss management: is there still a role for titanium cages and cemented cups? Hip Int 2025:11207000251315837. [PMID: 39894957 DOI: 10.1177/11207000251315837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
INTRODUCTION Bone loss represents a formidable challenge in hip revision surgery. Recent advances in revision implants and the use of new materials have diminished the need for cup-cages in addressing severe acetabular bone loss, which, however, may still be indicated in certain situations. The objectives of this study are to assess survival, functional outcomes, and reasons for the failure of managing severe acetabular bone loss with titanium cages and cemented cup. METHODS 57 patients treated with an acetabular cage and cemented cup for acetabular revision between January 2014 and July 2018 were retrospectively evaluated. Inclusion criteria comprised cup loosening with bone loss greater than IIB according to Paprosky classification, and a follow-up of at least 60 months. RESULTS The average age at the time of surgery was 74.8 years (SD 10.7). The acetabular bone defect according to the Paprosky classification was: type II C in 10 patients (21.7%), type III A in 21 patients (45.7%) and type III B in 15 patients (32.6%). Pelvic discontinuity was present in 35 cases (76.1%). The average follow-up during the final assessment was 78.3 months (SD 14.9). The reoperation rate was 13% (6 patients) and the complications rate was 17.4%. The survivorship of the implant was 87% at final follow-up.At the final follow-up average HHS was 89.4 ± 13.4, average WOMAC 15.7 ± 17.2, average HOOS 81.3 ± 19 and average FJS-12 83.7 ± 17.2. At the final follow-up, 32 patients (80%) showed excellent or good outcomes (HHS >80). CONCLUSIONS In the presence of severe bone defects, acetabular reconstruction using titanium acetabular cages and cemented UHMWPE cups remains a valid treatment option. Specifically, this acetabular reconstruction system should be favoured for elderly or low-demand patients, with the possibility of using it safely even in patients with pelvic discontinuity.
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Affiliation(s)
- Loris Perticarini
- Section of Prosthetic Surgery with Robotics - Sports Traumatology, Orthopaedics and Traumatology, Fondazione Poliambulanza, Brescia, Italy
| | - Luca Andriollo
- Section of Prosthetic Surgery with Robotics - Sports Traumatology, Orthopaedics and Traumatology, Fondazione Poliambulanza, Brescia, Italy
- Orthopaedics and Traumatology, Catholic University of the Sacred Heart, Rome, Italy
- Artificial Intelligence Centre, Alma Mater Europaea University, Vienna, Austria
| | - Stefano M P Rossi
- Section of Prosthetic Surgery with Robotics - Sports Traumatology, Orthopaedics and Traumatology, Fondazione Poliambulanza, Brescia, Italy
- Link Campus University, Rome, Italy
- Biomedical Sciences Area, IUSS University School for Advanced Studies, Pavia, Italy
| | - Rudy Sangaletti
- Section of Prosthetic Surgery with Robotics - Sports Traumatology, Orthopaedics and Traumatology, Fondazione Poliambulanza, Brescia, Italy
| | - Francesco Benazzo
- Section of Prosthetic Surgery with Robotics - Sports Traumatology, Orthopaedics and Traumatology, Fondazione Poliambulanza, Brescia, Italy
- Biomedical Sciences Area, IUSS University School for Advanced Studies, Pavia, Italy
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Madanipour S, Neufeld ME, Robinson T, Masri BA, Garbuz DS, Howard LC. Cup-Cage Reconstruction for Pelvic Discontinuity: Encouraging Long-Term Survival. J Arthroplasty 2025:S0883-5403(25)00040-3. [PMID: 39880051 DOI: 10.1016/j.arth.2025.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 01/16/2025] [Accepted: 01/17/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Pelvic discontinuity (PD) poses a difficult challenge in revision total hip arthroplasty. There is a paucity of evidence assessing 5- to 10-year outcomes of cup cages for PD. This study aimed to review the survivorship and outcomes of cup-cage constructs for PD. METHODS Cases without PD or with < 2-year follow-up were excluded. There were 48 cup-cage revisions identified with a mean follow-up of 7.2 years (range, 2 to 20). The mean age was 77 years, and 71% were women. Kaplan-Meier analysis was used to determine survival with all-cause and aseptic loosening rerevision as endpoints. Secondary outcomes included radiological failures and patient-reported outcomes. RESULTS All-cause rerevision survival was 80% (95% confidence interval [CI]: 0.70 to 0.93) at 5 years and 68% (95% CI: 0.54 to 0.85) at 10 years. Rerevision survival for aseptic loosening of the cup-cage construct was 95% (95% CI: 0.89 to 1.00) at 5 years and 85% (95% CI: 0.74 to 0.98) at 10 years. There were 13 (27%) patients who underwent rerevision at a mean of 45 months post revision total hip arthroplasty (range, 1 to 112). Aseptic loosening prompted rerevision in five of 48 (10%) cases at a mean of 68 months (range, 29 to 98). Of these, three required cup revisions for loosening and two required isolated cage/liner revisions with well-fixed cups. There were three patients who had resection arthroplasty for chronic infection. There were three patients revised for instability with liner exchange or femoral revision only, as the cup-cage constructs had not failed. Patient-reported pain (mean Western Ontario and McMaster Universities Arthritis Index: 83.5) and function (mean Western Ontario and McMaster Universities Arthritis Index function: 75.4; Oxford Hip Score: 71.2) were acceptable. CONCLUSIONS Cup-cage reconstruction is a good solution for PD with encouraging five-year to 10-year results and acceptable survivorship and patient-reported outcome measures.
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Affiliation(s)
- Suroosh Madanipour
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael E Neufeld
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Robinson
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa C Howard
- Department of Orthopaedic Surgery, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, British Columbia, Canada
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Mu W, Xu B, Wahafu T, Wang F, Guo W, Zou C, Cao L. What Are the Functional, Radiographic, and Survivorship Outcomes of a Modified Cup-cage Technique for Pelvic Discontinuity? Clin Orthop Relat Res 2024; 482:2149-2160. [PMID: 38991223 PMCID: PMC11557016 DOI: 10.1097/corr.0000000000003186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Pelvic discontinuity (PD) presents a complex challenge in revision hip arthroplasty. The traditional cup-cage construct, which involves a screw-secured porous metal cup and an overlying antiprotrusio cage, has shown promising mid- to long-term results. However, there is limited information on the outcomes of modifications to the original technique. Our study aims to evaluate a modified technique in which the cup position is determined by the placement of the overlying cage, allowing for adjustments to achieve optimal orientation. QUESTIONS/PURPOSES Among patients treated for PD with a cup-cage construct in which the cup position was dictated by the position of the cage: (1) What are Harris hip scores achieved at a minimum of 2 years of follow-up? (2) What is the Kaplan-Meier survivorship free from aseptic loosening or component migration? (3) What is the Kaplan-Meier survivorship free from revision for any reason? (4) What surgical complications are associated with the procedure? METHODS Between October 2013 and January 2022, we performed 805 acetabular revisions. Among these, 33 patients with PD confirmed intraoperatively were considered potentially eligible for a cup-cage construct; no other method of surgical management was used. We performed 64% (21 of 33) of these procedures from October 2013 to January 2018, with 6% (2 of 33) of patients lost to follow-up before the minimum study follow-up of 2 years; these 19 patients were monitored over a period ranging from 70 to 115 months. A further 12 patients underwent this procedure from January 2018 to January 2022, with one lost to follow-up before the minimum study follow-up of 2 years; the other patients met the minimum 2-year follow-up requirement. The remaining 30 patients with data analyzed here (10 men, 20 women) had a mean ± SD age of 61 ± 12 years and a median BMI of 29 kg/m 2 (range 20 to 33 kg/m 2 ) at the time of revision surgery. Twenty-one patients underwent revision due to aseptic loosening, and nine due to periprosthetic joint infection (PJI). The causes of PD in our patients were as follows: cup aseptic loosening without significant osteolysis in 20% (6 of 30), where the loose cup caused erosion of the host bone, leading to PD; PJI in 30% (9 of 30); intraoperative iatrogenic PD in 3% (1 of 30); and osteolysis in 47% (14 of 30), which also resulted in aseptic loosening. The median follow-up time was 79 months (range 25 to 115 months). The Harris hip score was used to evaluate clinical outcomes, with preoperative values compared with the most recent follow-up. Radiographs were reviewed by two experienced surgeons at each follow-up visit to assess component loosening (defined as migration > 5 mm or the presence of circumferential radiolucent lines) or clear migration. PD was considered healed if bridging callus or trabecular bone was visible across the site of the discontinuity. Complications were assessed through a comprehensive review of electronic medical records. Kaplan-Meier analysis was used to estimate implant survivorship and radiographic loosening, with aseptic loosening or component migration as the endpoint, as well as survivorship free from any reoperation. RESULTS The Harris hip score improved from a median of 39 (range 30 to 66) preoperatively to a median of 76 (range 30 to 90) postoperatively (median difference 33 [range 2 to 48]; p < 0.01). Within the limitations of two-dimensional (2D) radiographic imaging, successful bone graft integration and the healing of PD were noted in 83% (25 of 30) of patients. Kaplan-Meier survivorship free from radiographic signs of aseptic loosening or component migration was 100% (95% CI 100% to 100%) at 115 months. When any revision related to the acetabular component was considered the endpoint, survivorship free from acetabular component revision at 115 months after revision surgery was 100% (95% CI 100% to 100%). When the need for any reoperation was considered the endpoint, survivorship free from needing reoperation at 115 months after revision surgery was 85% for all patients (95% CI 73% to 100%). When including only patients with a follow-up time of > 4 years (20 of 30), survivorship free from needing reoperation at 115 months after revision surgery was 90% (95% CI 78% to 100%). Postoperative complications during the follow-up period included one early dislocation on the fifth day after surgery, treated with closed reduction and 6 weeks of abduction bracing. One femoral stem loosening occurred at 56 months postoperatively, although the acetabular component remained securely fixed; this patient declined revision surgery. One patient experienced a dislocation 5 months after surgery but refused treatment and opted for prolonged bed rest. Additionally, one patient underwent a debridement, antibiotics, and implant retention procedure 1 week after the revision surgery and subsequently showed no signs of infection at the latest follow-up, 38 months postoperatively. CONCLUSION Our study highlights the effectiveness of a modified cup-cage technique in complex hip revisions, showing promising results in terms of construct survivorship and low complication rates. Surgeons could consider delaying screw fixation until after positioning the cage within the porous cup to allow for optimal adjustment and using metal augments for severe bone defects to achieve better alignment. Surgeon experience with the cup-cage technique is crucial for achieving optimal outcomes. Future studies should focus on long-term follow-up visits to assess the durability and effectiveness of these modifications and explore the comparative effectiveness versus other methods, such as custom triflange components and jumbo cups with distraction. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Wenbo Mu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Boyong Xu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Tuerhongjiang Wahafu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Fei Wang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Wentao Guo
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Chen Zou
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, PR China
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, PR China
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Tarabichi S, Baker CM, Lizcano JD, Abe EA, Goh GS, Courtney PM. Porous Metal Augments Have Comparable Outcomes to Other Constructs for Severe Acetabular Bone Loss at Mid-Term Follow-up. J Arthroplasty 2024; 39:3041-3045. [PMID: 38844248 DOI: 10.1016/j.arth.2024.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Acetabular reconstruction options in the setting of severe bone loss remain limited, with few comparative studies published to date. The purpose of this study was to compare the outcomes of revision total hip arthroplasty (THA) for severe bone loss using porous metal augments to cup cage and triflange prostheses. METHODS We reviewed a consecutive series of 180 patients who had Paprosky 3A or 3B acetabular defects and underwent revision THA. Patients treated with porous augments (n = 141) were compared with those who received cup cages or triflange constructs (n = 39). Failure of the acetabular construct was defined as undergoing acetabular revision surgery or radiographic evidence of loosening. RESULTS There was no difference in acetabular component survivorship in patients undergoing revision THA with porous augments or a cage or triflange prosthesis (92.2 versus 87.2%, P = .470) at a mean follow-up of 6.6 ± 3.4 years. Overall, survivorship free from any revision surgery was comparable between the 2 groups (78.7 versus 79.5%, P = .720). There was also no difference in dislocation (5.7 versus 10.3%, P = .309) or periprosthetic joint infection rates (7.8 versus 10.3%, P = .623). In a subgroup analysis of patients who had pelvic discontinuity (n = 47), survivorship free from any revision surgery was comparable between the 2 groups (79.5 versus 72.2%, P = .543). CONCLUSIONS Porous metal augments in the setting of severe acetabular bone loss demonstrated excellent survivorship at intermediate-term (mean 6.6 years follow-up, even in cases of pelvic discontinuity, with comparable outcomes to cup cages and triflanges. Instability and infection remain major causes of failure in this patient population, and long-term follow-up is needed.
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Affiliation(s)
- Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Juan D Lizcano
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth A Abe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Chaudhry F, Daud A, Greenberg A, Braunstein D, Safir OA, Gross AE, Kuzyk PR. Cup-Cage Construct for Treatment of Severe Acetabular Bone Loss in Revision Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Mean Follow-Up of 7.7 Years. J Arthroplasty 2024; 39:2555-2560. [PMID: 39002767 DOI: 10.1016/j.arth.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Acetabular reconstruction in the context of massive acetabular bone loss is challenging. Achieving implant stability in these situations requires special considerations. The cup-cage construct is a treatment option that addresses this issue. This study evaluates survivorship, complications, and functional outcomes using the cup-cage construct. METHODS A total of 131 cup-cage implants (129 patients) were identified from our retrospective review of revision total hip arthroplasties from January 2003 to January 2022. Among these cases, 100 (76.3%) were women, the mean age at the time of surgery was 68 years (range, 29 to 92; SD [SD], 12.4), and the mean follow-up was 7.7 years (range, 0.02 to 20.3; SD, 5.1). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery and/or failure of the cup-cage reconstruction. RESULTS At a mean follow-up of 7.7 years, the cup-cage construct survivorship due to all-cause failure was 83.9% (95% CI [confidence interval]: 77.6 to 90.2) at 5 years with 88 hips at risk, 74.8% (95% CI: 66.2 to 83.4) at 10 years with 38 hips at risk, and 69.8% (95% CI: 59.4 to 80.2) at 15 years with 11 hips at risk. The survivorship due to failure from aseptic loosening was 96.7% (95% CI: 93.6 to 99.8) at 5 years with 88 hips at risk and 95.5% (95% CI: 91.6 to 99.4) at 10 and 15 years with 38 and 11 hips at risk, respectively. The revision rate for aseptic loosening of the cup and/or cage, infection, dislocation, and aseptic loosening of the femoral stem was 5 of 131 (3.8%), 12 of 131 (9.1%), 10 of 131 (7.6%), and 2 of 131 (1.5%). CONCLUSIONS The cup-cage construct is a reliable treatment option for the treatment of various acetabular defects. There are favorable survivorship, clinical, and radiographic outcomes, with a satisfactory complication rate.
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Affiliation(s)
- Faran Chaudhry
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anser Daud
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arieh Greenberg
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Doris Braunstein
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan E Gross
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paul R Kuzyk
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Melnic CM, Salimy MS, Minutillo GT, Paprosky WG, Sheth NP. Acetabular Distraction Technique: A Multicenter Study With a Minimum 2-Year Radiographic Follow-Up. J Arthroplasty 2024; 39:S398-S403. [PMID: 38401613 DOI: 10.1016/j.arth.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity. METHODS Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct. RESULTS Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up. CONCLUSIONS To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory T Minutillo
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Sanghavi SA, Paprosky WG, Sheth NP. Evaluation and Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty: A 10-year Update. J Am Acad Orthop Surg 2024; 32:e466-e475. [PMID: 38412446 DOI: 10.5435/jaaos-d-23-00645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery. The use of cemented reconstruction techniques has declined, and contemporary practice trends have involved the increasing use of highly porous hemispherical shells in conjunction with modular porous metal augments, which can successfully treat most acetabular revisions. Noncemented treatment options for the management of acetabular bone loss during revision include conventional porous/modular highly porous hemispherical implants, nonmodular highly porous implants with cementable acetabular liners, cup-cage reconstruction, oblong cups, and triflange reconstruction. These options can be combined with modular porous metal augments, structural allografts, impaction grafting, or reconstruction cages. Acetabular distraction is a newer technique for chronic pelvic discontinuity, which is used in conjunction with off-the-shelf revision acetabular shells and modular porous metal augments. This review is an update over the past decade, highlighting studies with mid to long-term follow-up, and presents the advantages, disadvantages, and principles associated with each of the most commonly used reconstructive techniques.
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Affiliation(s)
- Sahil A Sanghavi
- From the Department of Arthroplasty, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India (Sanghavi), Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL (Paprosky), Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA (Sheth)
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9
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Chaudhry F, Daud A, Greenberg A, Braunstein D, Safir OA, Gross AE, Kuzyk PR. Cup-cage constructs in revision total hip arthroplasty for pelvic discontinuity. Bone Joint J 2024; 106-B:66-73. [PMID: 38688477 DOI: 10.1302/0301-620x.106b5.bjj-2023-0842.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Pelvic discontinuity is a challenging acetabular defect without a consensus on surgical management. Cup-cage reconstruction is an increasingly used treatment strategy. The present study evaluated implant survival, clinical and radiological outcomes, and complications associated with the cup-cage construct. Methods We included 53 cup-cage construct (51 patients) implants used for hip revision procedures for pelvic discontinuity between January 2003 and January 2022 in this retrospective review. Mean age at surgery was 71.8 years (50.0 to 92.0; SD 10.3), 43/53 (81.1%) were female, and mean follow-up was 6.4 years (0.02 to 20.0; SD 4.6). Patients were implanted with a Trabecular Metal Revision Shell with either a ZCA cage (n = 12) or a TMARS cage (n = 40, all Zimmer Biomet). Pelvic discontinuity was diagnosed on preoperative radiographs and/or intraoperatively. Kaplan-Meier survival analysis was performed, with failure defined as revision of the cup-cage reconstruction. Results The five-year all-cause survival for cup-cage reconstruction was 73.4% (95% confidence interval (CI) 61.4 to 85.4), while the ten- and 15-year survival was 63.7% (95% CI 46.8 to 80.6). Survival due to aseptic loosening was 93.4% (95% CI 86.2 to 100.0) at five, ten, and 15 years. The rate of revision for aseptic loosening, infection, and dislocation was 3/53 (5.7%), 7/53 (13.2%), and 6/53 (11.3%), respectively. The mean leg length discrepancy improved (p < 0.001) preoperatively from a mean of 18.2 mm (0 to 80; SD 15.8) to 7.0 mm (0 to 35; SD 9.8) at latest follow-up. The horizontal and vertical hip centres improved (p < 0.001) preoperatively from a mean of 9.2 cm (5.6 to 17.5; SD 2.3) to 10.1 cm (6.2 to 13.4; SD 2.1) and 9.3 cm (4.7 to 15.8; SD 2.5) to 8.0 cm (3.7 to 12.3; SD 1.7), respectively. Conclusion Cup-cage reconstruction provides acceptable outcomes in the management of pelvic discontinuity. One in four constructs undergo revision within five years, most commonly for periprosthetic joint infection, dislocation, or aseptic loosening.
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Affiliation(s)
- Faran Chaudhry
- University of Toronto Temerty Faculty of Medicine, Toronto, Canada
| | - Anser Daud
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Arieh Greenberg
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | | | - Oleg A Safir
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Allan E Gross
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
| | - Paul R Kuzyk
- Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada
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10
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Wassilew GI, Zimmerer A, Fischer M, Nonnenmacher L, O'Hara L, Hube R. Reconstruction of Paprosky IIIB acetabular defects with porous tantalum shells and augments using the footing technique. Bone Joint J 2024; 106-B:54-58. [PMID: 38688499 DOI: 10.1302/0301-620x.106b5.bjj-2023-0523.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The use of a porous metal shell supported by two augments with the 'footing' technique is one solution to manage Paprosky IIIB acetabular defects in revision total hip arthroplasty. The aim of this study was to assess the medium-term implant survival and radiological and clinical outcomes of this technique. Methods We undertook a retrospective, two-centre series of 39 hips in 39 patients (15 male, 24 female) treated with the 'footing' technique for Paprosky IIIB acetabular defects between 2007 and 2020. The median age at the time of surgery was 64.4 years (interquartile range (IQR) 54.4 to 71.0). The median follow-up was 3.9 years (IQR 3.1 to 7.0). Results The cumulative medium-term survival of the acetabular construct was 89%. Two hips (5.1%) required further revision due to shell loosening, one hip (2.6%) due to shell dislocation, and one hip (2.6%) due to infection. The median Harris Hip Score improved significantly from 47 points (IQR 41.5 to 54.9) preoperatively to 80 points (IQR 73.5 to 88.6) at the latest follow-up (p < 0.001). Conclusion The reconstruction of Paprosky IIIB acetabular defects with porous tantalum shells and two augments using the 'footing' technique showed excellent medium-term results. It is a viable option for treating these challenging defects.
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Affiliation(s)
- Georgi I Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Zimmerer
- Diakonieklinikum Stuttgart, Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, Stuttgart, Germany
| | - Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Laurence O'Hara
- Trauma and Orthopaedics, University Hospitals Dorset, Bournemouth, UK
| | - Robert Hube
- Orthopädische Chirurgie München, Munich, Germany
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11
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Bellova P, Reich MC, Grothe T, Günther KP, Stiehler M, Goronzy J. Treatment of Severe Acetabular Defects With an Antiprotrusio Cage and Trabecular Metal Augments - Clinical and Radiographic Results After a Mean Follow-Up of 6.6 Years. J Arthroplasty 2023; 38:2415-2422. [PMID: 37271233 DOI: 10.1016/j.arth.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Large acetabular bone defects present a serious challenge in revision total hip arthroplasty. The off-label use of antiprotrusio cages in combination with tantalum augments is a promising treatment option in these difficult situations. METHODS Between 2008 and 2013, 100 consecutive patients underwent acetabular cup revision with a cage-augment combination in Paprosky 2 and 3 defect types (including pelvic discontinuities). There were 59 patients available for follow-up. The primary endpoint was the explantation of the cage-and-augment construct. The secondary endpoint was acetabular cup revision for any reason. Also, radiographic and functional outcomes (Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score) were evaluated. Implant survival rates were determined using a Kaplan-Meier analysis. The significance level was set at P < .05. RESULTS Explantation-free survivorship of the "Cage-and-Augment" system was 91.9% after a mean follow-up of 6.2 years (range, 0 to 12.8). All 6 explantations were due to periprosthetic joint infection (PJI). The overall revision-free implant survival rate was 85.7%, including 6 additional liner revisions due to instability. In addition, 6 early PJI occurred, which were successfully treated with debridement, irrigation, and implant retention. We did observe one patient who had radiographic loosening of the construct without necessity for treatment. CONCLUSION The combination of an antiprotrusio cage with tantalum augments is a promising technique in treating large acetabular defects. A major risk of PJI and instability due to large bone and soft tissue defects needs special attention.
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Affiliation(s)
- Petri Bellova
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Tim Grothe
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Peter Günther
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maik Stiehler
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens Goronzy
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
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12
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Christie MC, DeBoer DK, Morrison JC, Brinson MF, Christie MJ. Bridging Massive Acetabular Defects With the Triflange Cup: 10- to 28-Year Results. J Arthroplasty 2023; 38:2423-2428. [PMID: 37271239 DOI: 10.1016/j.arth.2023.05.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Massive acetabular bone loss, encountered complex primary or revision total hip arthroplasty, remains a reconstructive challenge. The custom triflange cup reliably achieves both early fixation and longer-term stability. This study presents the 10-year minimum three-surgeon follow-up of acetabular defects managed with a custom triflange component. METHODS All patients who underwent a custom triflange acetabular component implantation from January 1992 to December 2009 were identified. Demographics, implant data, outcomes, and reoperations were collected and analyzed. Bone defects in all cases were Paprosky type IIIA, IIIB, or IV. A total of 233 patients (241 hips) underwent implantation of a custom triflange during the study period. There were 81 patients (83 hips) who died prior to minimum follow-up and 84 patients (88 hips) had minimum follow-up of 10 years (mean 15.2; range, 10 to 28), or failure prior to 10 years. RESULTS Complications requiring additional surgery occurred in 43 hips (49%). There were 10 revisions for failure (11.4%); four were due to recurrent infection, three for aseptic loosening, and one for recurrent infection with all revised to a new triflange. There was one patient who was resected to a Girdlestone for infection and one patient was revised for infection to a bipolar hemiprosthesis due to a healed discontinuity. CONCLUSION To our knowledge, this study represents the largest cohort and longest follow-up in the current literature and demonstrates excellent survivorship and clinical results at an average of 15 years follow-up. The component was retained in 89% of cases.
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Affiliation(s)
| | - David K DeBoer
- Southern Joint Replacement Institute, Nashville, Tennessee
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13
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Wood MJ, Al-Jabri T, Zaghloul A, Lanting B, Giannoudis PV, Hart AJ. Periprosthetic acetabular fractures as a complication of total hip arthroplasty. Injury 2023; 54:111058. [PMID: 37748235 DOI: 10.1016/j.injury.2023.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ahmed Zaghloul
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alister James Hart
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, HA7 4LP, United Kingdom
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14
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Pandey AK, Zuke WA, Surace P, Kamath AF. Management of acetabular bone loss in revision total hip replacement: a narrative literature review. ANNALS OF JOINT 2023; 9:21. [PMID: 38694811 PMCID: PMC11061657 DOI: 10.21037/aoj-23-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/31/2023] [Indexed: 05/04/2024]
Abstract
Background and Objective Due to growing numbers of primary total hip replacement (THR), the revision THR burden is also increasing. Common indications for revision are osteolysis, infection, instability, and mechanical failure of implants, which can cause acetabular bone loss. Massive acetabular bone defects and pelvic discontinuity are extremely challenging problems. Many techniques have been utilized to address bone loss while maintaining a stable revision THR. Structural allografts, cemented prosthesis, reconstruction cages, and custom triflanged implants have all been used successfully albeit with relatively high complications rates. We have tried to highlight emerging trends to utilize Custom Made Monoflange or Triflange Acetabular Components to reconstruct massive acetabular defects with favourable midterm implant survival, better functional outcomes, relatively lesser complications, and almost similar cost of prosthesis as compared to conventional reconstruction techniques. However, long-term data and study is still recommended to draw a definitive conclusion. Methods In this narrative review article, we searched PubMed and Cochrane for studies on managing acetabular bone loss in revision THR with a focus on recent literature for mid to long-term outcomes and compared results from various studies on different reconstruction methods. Key Content and Findings Hemispherical cementless acetabular prosthesis with supplemental screws are commonly utilized to manage mild to moderate acetabular bone loss. Recent trends have shown much interest and paradigm shift in patient specific custom triflange acetabular components (CTAC) for reconstructing massive acetabular defects and pelvic discontinuity. Studies have reported high patient satisfaction, improved patient reported daily functioning, high mid-term implant survival, similar complications, and encouraging all cause re-revision rate. However, more prospective and quality studies with larger sample sizes are needed to validate the superiority of CTACs over conventional acetabular implants. Conclusions There is no consensus regarding the best option for reconstructing massive acetabular defects. Thorough preoperative workup and planning is an absolute requirement for successful revision THR. While most of the moderate acetabular bone loss can be managed with cementless hemispherical acetabular shells with excellent long-term outcomes, reconstructing massive acetabular bone defects in revision THR remains a challenge. Depending on the size and location of the defect, various constucts have demonstrated long-term success as discussed in this review, but complications are not negligible. CTACs provide a treatment for massive bone loss that may be otherwise difficult to achieve anatomic stability with other constructs. Although long-term data is sparse, the cost and complication rate is comparable to other reconstruction methods.
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Affiliation(s)
- Awadhesh K. Pandey
- Ongwediva Medipark Hospital, Ongwediva, Namibia
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - William A. Zuke
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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15
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Kim HS, Kim JW, Chang JS, Kim CH. Revision Total Hip Arthroplasty Utilizing an Acetabular Reinforcement Ring with a Metal Augment: A Minimum Eight-Year Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1036. [PMID: 37374240 DOI: 10.3390/medicina59061036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An acetabular reinforcement ring (ARR) with a structural allograft is conventionally used to treat large acetabular bone defects or discontinuity during revision hip arthroplasty. However, ARR is prone to failure due to bone resorption and lack of incorporation. Here, we investigated the surgical outcomes of the patients who underwent revision total hip arthroplasty (THA) using ARR combined with a metal augment (MA). Materials and Methods: We retrospectively reviewed data from 10 consecutive patients who had a minimum 8-year follow-up after revision hip arthroplasty using ARR with MA in Paprosky type III acetabular defect. We collected patient demographics, surgical details, clinical scores (including Harris Hip Score (HHS)), postoperative complications, and 8-year survival rates. Results: Six male and four female patients were included. The mean age was 64.3 years, and the mean follow-up duration was 104.3 months (96.0-112.0 months). Trauma-related diagnosis was the most common reason for index surgery. Three patients underwent all component revision, and seven underwent cup revision. Six were confirmed as Paprosky type IIIA and four as type IIIB. The mean HHS at the final follow-up was 81.5 (72-91). One patient was diagnosed with prosthetic joint infection at the 3-month follow-up; therefore, the minimum 8-year survival rate with our technique was 90.0% (95% confidence interval, 90.3-118.5%). Conclusions: The satisfactory mid- to long-term results of revision THA suggest that ARR combined with tantalum MA is a viable revision option for treating severe acetabular defects with pelvic discontinuity.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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16
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Di Laura A, Henckel J, Hart A. Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results. JB JS Open Access 2023; 8:e22.00120. [PMID: 37197697 PMCID: PMC10184995 DOI: 10.2106/jbjs.oa.22.00120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The management of massive acetabular defects at the time of revision hip surgery is challenging. Severe pelvic bone loss and the heterogeneity and quality of the remaining bone stock can compromise the fixation and mechanical stability of the implant. Methods We reviewed a database of consecutive patients who had undergone acetabular reconstruction with the use of a custom 3D-printed implant with a dual-mobility bearing for the treatment of Paprosky type-3B defects between 2016 and 2019. Functional and radiological outcomes were assessed. Results A total of 26 patients (17 women and 9 men) with a minimum follow-up of 36 months (median, 53 months; range, 36 to 77 months) were identified. The median age at surgery was 69 years (range, 49 to 90 years), and 4 patients had pelvic discontinuity. The cumulative implant survivorship was 100%. The median Oxford Hip Score improved significantly from 8 (range, 2 to 21) preoperatively to 32 (range, 14 to 47) postoperatively (p = 0.0001). One patient had a transient sciatic nerve palsy, 1 hip dislocated 6 months postoperatively and was managed nonoperatively, and 1 infection recurred. No patient had a fracture. Radiographic evaluation showed bone ingrowth at the bone-implant interface in 24 patients (92%) at ≥12 months of follow-up and showed no evidence of implant loosening or migration at the latest follow-up (3 to 6 years). Conclusions Excellent functional improvement, implant survivorship, and osseointegration were recorded in the patient cohort. Accurate preoperative planning and the adoption of custom 3D-printed implants showed promising results in complex revision hip surgery. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anna Di Laura
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
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17
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Murylev V, Muzychenkov A, Elizarov P, Kukovenko G, Alekseev S, Zhuchkov AG, Erokhin NE. Long-term functional results of revision hip replacement using Burch-Schneider cages. J Orthop 2023; 37:53-58. [PMID: 36974092 PMCID: PMC10039112 DOI: 10.1016/j.jor.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results. Methods Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B. Results Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3. Conclusions The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.
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Affiliation(s)
- Valeriy Murylev
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexey Muzychenkov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Pavel Elizarov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Grigoriy Kukovenko
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Semyon Alekseev
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexander G. Zhuchkov
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Nicolay E. Erokhin
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
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18
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Hinckley NB, Beauchamp CP, Christopher ZK, Schwartz AJ, Ogunleye T, Goulding KA. What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium "monoflange". J Surg Oncol 2023; 127:480-489. [PMID: 36255157 DOI: 10.1002/jso.27124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Innovations in machined and three-dimensionally (3D) printed implant technology have allowed for customized complex pelvic reconstructions. We sought to determine the survivorship of custom hemipelvis reconstruction using ilium-only fixation at a minimum 2-year follow-up, their modes of failure, and the postoperative complications resulting from the procedure. METHODS A retrospective review identified 12 consecutive patients treated with custom hemipelvis reconstruction. Indications for surgery were bone tumor requiring internal hemipelvectomy (four patients) or multiply revised, failed hip arthroplasty with massive bone loss (eight patients). All patients had a minimum of 2-year follow-up with a mean of 60.5 months. Kaplan-Meier survivorship analysis was determined for all patients. Postoperative complications and reoperations were categorized for all patients. RESULTS At a mean of 60.5 months, 11 of 12 patients had retained their custom implant (92% survivorship). One implant was removed as a result of an acute periprosthetic joint infection (PJI). There were no cases of aseptic loosening. Seven of 12 patients required reoperation (three PJI; two dislocations; two superficial wound complications), with five patients going on to reoperation-free survival. CONCLUSIONS Custom hemipelvis reconstruction utilizing an ilium monoflange provides durable short-term fixation at a minimum 2-year follow-up. Reoperation for infection and dislocation is common.
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Affiliation(s)
| | | | | | - Adam J Schwartz
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
| | - Temi Ogunleye
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Krista A Goulding
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
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19
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Faraj S, de Windt TS, van Hooff ML, van Hellemondt GG, Spruit M. Custom-made acetabular revision arthroplasty for pelvic discontinuity: Can we handle the challenge? : a prospective cohort study. Bone Jt Open 2023; 4:53-61. [PMID: 36718581 PMCID: PMC10011926 DOI: 10.1302/2633-1462.42.bjo-2022-0159.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS The aim of this study was to assess the clinical and radiological results of patients who were revised using a custom-made triflange acetabular component (CTAC) for component loosening and pelvic discontinuity (PD) after previous total hip arthroplasty (THA). METHODS Data were extracted from a single centre prospective database of patients with PD who were treated with a CTAC. Patients were included if they had a follow-up of two years. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance and clinical relevance. RESULTS A total of 18 females with 22 CTACs who had a mean age of 73.5 years (SD 7.7) were included. A significant improvement was found in HOOS (p < 0.0001), mOHS (p < 0.0001), EQ-5D-3L utility (p = 0.003), EQ-5D-3L NRS (p = 0.013), VAS pain rest (p = 0.008), and VAS pain activity (p < 0.0001) between baseline and final follow-up. Minimal clinically important improvement in mOHS and the HOOS Physical Function Short Form (HOOS-PS) was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. CONCLUSION CTAC in patients with THA acetabular loosening and PD can result in stable constructs and significant improvement in functioning and health-related quality of life at two years' follow-up. Further follow-up is necessary to determine the mid- to long-term outcome.Cite this article: Bone Jt Open 2023;4(2):53-61.
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Affiliation(s)
- Sayf Faraj
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Tommy S de Windt
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Miranda L van Hooff
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.,Department of Orthopedic Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Maarten Spruit
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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Galuzinskii O, Chornyi V, Kozik Y, Fedin Y. TOTAL HIP JOINT REPLACEMENT USING A CUSTOM TRIFLANGE ACETABULAR COMPONENT (LITERATURE REVIEW). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2694-2699. [PMID: 38290035 DOI: 10.36740/wlek202312120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim: The purpose of the article is to analyze the ways of solving the problem of revision hip joint replacement. The article discusses the methods of treatment using a custom triflange acetabular component. PATIENTS AND METHODS Materials and methods: The analysis of 37 literary sources includes a discussion of the features of the use of individual triflange acetabular components and errors in revision hip arthroplasty, which are associated with various factors. CONCLUSION Conclusions: A review of studies devoted to the use of custom triflange acetabular components confirms the effectiveness in the early postoperative period in the treatment of critical acetabular defects and pelvic ring discontinuity. The CTAC use is particularly relevant in case of the pelvic ring disintegration, as it provides for the appropriate endoprosthesis adaptation with the healthy bone, as well as for the bone defects plastics and recovery of the hip joint biome¬chanics. So, the use of individual constructions is indicated for the patients with significant bone mass loss, where augment adaptation and adjustment is impossible. This method is used more often when there is no other alternative. Research results showed a trend that special three-flange components of the acetabulum have better long-term results compared to traditional standard components for large bone defects. Improving production and increasing the number of CTACs should reduce their cost. In summary, the custom triflange acetabulum components provide a personalized secure fit that can reduce the risk of complications and improve patient outcomes. In summary, the triple-flange acetabulum components provide a personalized secure fit that can reduce the risk of complications and improve patient outcomes.
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Affiliation(s)
- Olexander Galuzinskii
- LLC «OSTEONICA», KYIV, UKRAINE; R.E.KAVETSKY INSTITUTE OF EXPERIMENTAL PATHOLOGY, ONCOLOGY AND RADIOBIOLOGY NAS OF UKRAINE, KYIV, UKRAINE
| | | | - Yevhenii Kozik
- SI "INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS OF NAMS OF UKRAINE", KYIV, UKRAINE
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21
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Stiehler M, Günther KP, Goronzy J. [Strategies for cup revision]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:12-20. [PMID: 35759041 DOI: 10.1007/s00132-022-04271-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 01/19/2023]
Abstract
Hip arthroplasty revision management can range from simple procedures using standard implants to complex surgical interventions requiring the combined use of revision cups, metal augments, bone grafts, and antiprotrusio cages. The adequate restoration of biomechanics and function of the hip joint with reconstruction of the original center of rotation can be challenging. We present an overview of various available techniques with the associated implant and anchoring strategies and the respective clinical results depending on the acetabular defect situation.
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Affiliation(s)
- Maik Stiehler
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Haus 29, 01307, Dresden, Deutschland.
| | - Klaus-Peter Günther
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Haus 29, 01307, Dresden, Deutschland
| | - Jens Goronzy
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Haus 29, 01307, Dresden, Deutschland
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22
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El Ghazawy AK, Bassiony AA, Abdelazim H, Gameel S. Acetabular revision using trabecular titanium (Delta TT) revision cups: A retrospective case series. SICOT J 2022; 8:49. [PMID: 36562704 PMCID: PMC9879130 DOI: 10.1051/sicotj/2022049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The annual rate of primary THA has been increasing with new designs promoting THA in the younger population, therefore increasing rates and complexity of hip revision surgeries. Different types of acetabular defects in hip revisions, usually make the use of primary cementless cups quite difficult. In complex defects, using cages with cemented cups or combining cementless cups with metal augments, are possible reconstruction solutions. The Delta TT acetabular revision system provides a solution to complex defects combining the advantages of both cage construct and primary implants, with modularity that helps restore anatomical hip centre and biomechanics. The aim of this study is to evaluate the short-term results of the use of the Delta TT revision system in acetabular revision surgeries. TYPE OF THE STUDY A retrospective case series. METHODS 24 patients underwent acetabular revision using (Delta TT) revision system, from 2018 to 2021. The mean follow-up was 20.75 months. Clinical and functional outcomes were assessed using Harris Hip Score. RESULTS The use of the Delta TT revision system in acetabular revision surgery provided adequate pain relief, and early patient mobilization. The preoperative HHS mean of 29.88 improved to a mean of 85.21, at the last, follow-up. None of the patients developed periprosthetic infection or loosening or nerve palsy during the follow-up period. CONCLUSION Short-term clinical outcomes for the use of the Delta TT revision cup system in acetabular revision are encouraging with good functional outcomes and patient satisfaction.
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Affiliation(s)
- Ahmed K. El Ghazawy
- Department of Orthopedics surgery, Faculty of Medicine Ain Shams University Cairo 11566 Egypt,Corresponding author:
| | | | - Haytham Abdelazim
- Department of Orthopedics surgery, Faculty of Medicine Ain Shams University Cairo 11566 Egypt
| | - Saleh Gameel
- Department of Orthopedics surgery, Faculty of Medicine Ain Shams University Cairo 11566 Egypt
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23
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Cozzi Lepri A, Innocenti M, Galeotti A, Carulli C, Villano M, Civinini R. Trabecular titanium cups in acetabular revision arthroplasty: analysis of 10-year survivorship, restoration of center of rotation and osteointegration. Arch Orthop Trauma Surg 2022; 142:3523-3531. [PMID: 34782910 DOI: 10.1007/s00402-021-04243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS In case of severe bone loss, acetabular revision can be challenged using extra porous pure trabecular titanium (TT) revision cups designed to ensure enhanced iliac and ischiatic purchase. Aim of the study is to report on the clinical and radiological results of a TT acetabular component, evaluating functional outcome, restoration of the hip center of rotation and osteointegration. METHODS 85 patients, who underwent acetabular revision with a TT revision cup system between October 2009 and December 2018, were included in a retrospective study. Clinical outcome were assessed with Harris Hip Score (HHS). The hip rotation center was measured using the Pierchon method on the AP pelvis film. Loosening of the cup was determined according to the Kosashvili modification of Gill's criteria. Kaplan- Meier survivorship curve was performed. Results The mean follow-up was 6.12 years. The average HHS improved from 54.7 points to 89.7 points (p < 0.05). Two acetabular components (2.3%) were re-revised after a mean of 5.6 years, for aseptic loosening and for infection, with a progressive radiolucency and a > 5 mm vertical migration, respectively. The radiographic evaluation of the position of the hip rotation center revealed a statistically significant difference (p < 0.05) between the pre- and post-operative values. The hip rotation center was correctly restored within 5% of the reference Pierchon values in a percentage of 85.4% relative to horizontal parameters and within 8% in a percentage of 66.7% relative to vertical parameters. 5-year and 10-year survivorships were, respectively, 100% and 88%. CONCLUSIONS In case of severe bone loss, TT revision cup system allows for good restoration of center of rotation and osteointegration showing good 10-year survival rate.
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Affiliation(s)
- Andrea Cozzi Lepri
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy.
| | - Matteo Innocenti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Alberto Galeotti
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Christian Carulli
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Marco Villano
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
| | - Roberto Civinini
- Orthopedic Unit, Department of Health Sciences, University of Florence, C.T.O. Largo Palagi 1, 50139, Firenze, Italy
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24
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Winther SS, Petersen M, Yilmaz M, Kaltoft NS, Stürup J, Winther NS. Custom-made triflanged implants in reconstruction of severe acetabular bone loss with pelvic discontinuity after total hip arthroplasty consecutive cohort study. Bone Jt Open 2022; 3:867-876. [DOI: 10.1302/2633-1462.311.bjo-2022-0101.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS). Methods Retrospectively collected data of 38 patients (39 hips) with pelvic discontinuity treated with revision THA using a custom-made triflange acetabular component were analyzed. Minimum follow-up was two years (mean 5.1 years (2 to 11)). Results There were eight subsequent surgical interventions. Two failures (5%) of the triflange acetabular components were both revised because of deep infection. There were seven (18%) patients with dislocation, and five (13%) of these were treated with a constraint liner. One patient had a debridement, antibiotics, and implant retention (DAIR) procedure. In 34 (92%) hips the custom-made triflange component was considered stable, with a healed pelvic discontinuity with no aseptic loosening at midterm follow-up. Mean HHS was 80.5 (48 to 96). Conclusion The performance of the custom triflange implant in this study is encouraging, with high rates of discontinuity healing and osteointegration of the acetabular implant with no aseptic loosening at midterm follow-up. However, complications are not uncommon, particularly instability which we successfully addressed with constrained liners. Cite this article: Bone Jt Open 2022;3(11):867–876.
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Affiliation(s)
- Sebastian S. Winther
- Department of Orthopedic Surgery, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Michael Petersen
- Department of Orthopedic Surgery, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Müjgan Yilmaz
- Department of Orthopedic Surgery, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Nicolai S. Kaltoft
- Department of Radiology, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jens Stürup
- Department of Orthopedic Surgery, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Nikolaj S. Winther
- Department of Orthopedic Surgery, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
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25
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Huang Y, Tang H, Zhou Y, Shao H, Yang D, Zhou B. Extended Ischiopubic Fixation Using Porous Metal Augments in Cementless Acetabular Reconstruction during Revision Total Hip Arthroplasty. Orthop Surg 2022; 14:2480-2488. [PMID: 36028942 PMCID: PMC9531101 DOI: 10.1111/os.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The aims of this study were to introduce the definition, indication, and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical, radiographic results and complications of hips revised with EIF. Methods Patients who underwent revision THA utilizing the technique of EIF which was defined as securing the porous metal augment >5 mm deep into the ischium and/or pubic ramus to gain adequate mechanical support and fresh host bone for bony ingrowth in a single institution from February 2015 to February 2020 were retrospectively reviewed. After applying the inclusion and exclusion criteria, a total of 30 hips (28 patients) were eligible for the study and were enrolled. Four patients were lost to follow‐up postoperatively. The data of the remaining 24 patients (26 hips) were analyzed. The patients' clinical results were assessed using of the Harris Hip Score and any complications including postoperative periprosthetic joint infection, intraoperative fracture, postoperative periprosthetic fracture, dislocation, nerve palsy, hematoma or wound complication were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation, and cup orientation. Results The median age of these 25 patients was 62.00 (interquartile: 54.25–68.25) years, with a median body mass index (BMI) of 22.60 kg/m2 (interquartile: 21.49–25.12 kg/m2). A total of 12 (48%) patients were female. At a median duration of follow‐up of 49.16 months, 20 (80%) patients rated their satisfaction level as “very satisfied,” five (20%) were “satisfied.” The median HHS improved from 36.00 (interquartile range: 31.25–49.75) preoperatively to 81.00 (interquartile range: 74.75–88.25) at the most recent follow‐up (p < 0.001). No complications such as periprosthetic joint infection, intraoperative fracture, periprosthetic fracture, dislocation, nerve palsy, hematoma, or wound complication were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative centers of rotation to the anatomic center of rotation improved from 13.62 and 8.68 mm preoperatively to 4.42 and 4.19 mm at final follow‐up (p < 0.001). Conclusions Early follow‐up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation, and restoration of the center of rotation.
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Affiliation(s)
- Yong Huang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hao Tang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Baochun Zhou
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
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26
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Siddiqi A, Mahmoud Y, Rullán PJ, McLaughlin JP, Molloy RM, Piuzzi NS. Management of Periprosthetic Acetabular Fractures: A Critical Analysis and Review of the Literature. JBJS Rev 2022; 10:01874474-202208000-00003. [PMID: 35959937 DOI: 10.2106/jbjs.rvw.22.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Periprosthetic acetabular fractures are uncommon and infrequently the focus of studies. ➢ Acetabular fractures are occasionally recognized postoperatively when patients report unremitting groin pain weeks after surgery. ➢ The widespread use of cementless acetabular cups might lead to a higher number of fractures than are clinically detectable. ➢ Appropriate recognition, including mindfulness of preoperative patient and surgical risk factors, is critical to the successful management of acetabular complications.
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Affiliation(s)
- Ahmed Siddiqi
- Division of Adult Reconstruction, Orthopaedic Institute Brielle Orthopaedics, Manasquan, New Jersey
| | - Yusuf Mahmoud
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John P McLaughlin
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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27
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Garceau SP, Warschawski Y, Joly D, Safir OA, Gross AE, Kuzyk PR. Hip Arthroplasty With the Use of a Reconstruction Cage and Porous Metal Augment to Treat Massive Acetabular Bone Loss: A Midterm Follow-Up. J Arthroplasty 2022; 37:S636-S641. [PMID: 35271981 DOI: 10.1016/j.arth.2022.02.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Acetabular reconstruction in the context of massive acetabular bone loss is challenging. In rare scenarios where the extent of bone loss precludes shell placement (cup-cage), reconstruction at our center consisted of a cage combined with highly porous metal augments. This study evaluates survivorship, complications, and functional outcomes using this technique. METHODS Patients with minimum 2-year follow-up were included. Baseline characteristics were collected. Preintervention and postintervention ambulatory scores were collected. Kaplan-Meier (KM) survival analysis for cage failure requiring revision surgery was conducted. Binomial regression analysis was performed to assess for correlation of aseptic cage failure with baseline characteristics. Preintervention and postintervention ambulatory aid requirements were compared. RESULTS A total of 41 patients were identified. Mean follow-up was 6.4 years (range 2.8-11.0). Four (9.8%) aseptic cage revisions were identified. Aseptic KM survival analysis was 87.4% (95% confidence interval 75.3-99.6) at 10 years. Aseptic KM survival was 45.0% versus 92.8% at 9 years (P = .14) for patients with vs without pelvic discontinuity. KM survival for all-cause failure was 61.6% (95% confidence interval 44.0-79.2) at 10 years. Binomial regression did not demonstrate correlation of cage failure with baseline characteristics. Wilcoxon signed-rank test demonstrated a significant reduction in ambulatory aide requirement after surgery (mean rank 11.47 vs 9.00, Z = -2.95, P = .003). CONCLUSION In scenarios of massive acetabular bone loss where a cup-cage is not a viable option, good survivorship free from aseptic cage failure can be expected at mid-term follow-up using an antiprotrusio cage combined with porous metal augments. Success requires extensive experience in revision surgery.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Yaniv Warschawski
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Denis Joly
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Allan E Gross
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Paul R Kuzyk
- Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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28
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Acetabular Peri-Prosthetic Fractures—A Narrative Review. Medicina (B Aires) 2022; 58:medicina58050630. [PMID: 35630047 PMCID: PMC9143047 DOI: 10.3390/medicina58050630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures.
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29
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Three-dimensional-printed titanium implants for severe acetabular bone defects in revision hip arthroplasty: short- and mid-term results. INTERNATIONAL ORTHOPAEDICS 2022; 46:1289-1297. [PMID: 35384469 DOI: 10.1007/s00264-022-05390-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Severe acetabular bone defect is challenging in revision hip arthroplasty. In the present study, we aimed to present new treatment options with the 3D printing technique and analyze the clinical and radiographic outcomes of 3D-printed titanium implants for the treatment of severe acetabular bone defects in revision hip arthroplasty. METHODS A total of 35 patients with Paprosky type 3 bone defect and pelvic discontinuity (PD), who underwent hip revisions using 3D-printed titanium implants between 2016 and 2019 at our institution, were retrospectively reviewed. Patient-specific 3D-printed titanium augments and shells (strategy A) were used in 22 type 3A and two type 3B patients. Custom 3D-printed flanged components (strategy B) were used in 11 type 3B patients, including five PD. The clinical outcomes were evaluated with the Harris hip score (HHS). In addition, radiographic results were analyzed by the hip centre of rotation (V-COR and H-COR), implant failure, and survivorship. RESULTS The mean follow-up was 41.5 months (range, 16-62). The HHS was improved from 47.8 ± 8.2 pre-operatively to 78.1 ± 10.1 at one year follow-up and 86.4 ± 5.1 at the last follow-up (p < 0.01). Post-operative V-COR and H-COR of the operated side were 20.8 ± 2.0 mm and 30.2 ± 1.6 mm compared with 51.4 ± 4.1 mm and 33.9 ± 9.0 mm pre-operatively (p < 0.01). The complications included one dislocation and one partial palsy of the sciatic nerve. At the latest follow-up, no radiological component loosening or screw breakage was present. CONCLUSIONS 3D-printed titanium implants showed satisfactory short- and mid-term clinical and radiographic outcomes. It was an effective therapeutic regimen with a low rate of complications, providing a patient-specific and reliable strategy for the severe acetabular bone defect in revision hip arthroplasty.
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30
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Shiels SJ, Gosling O, Mehendale SA, Baker RP. Reconstruction with a cage outlives patients with metastatic disease involving the acetabulum. Hip Int 2022; 33:471-477. [PMID: 35238228 DOI: 10.1177/11207000211068098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The aim of this study was to determine whether patients treated with a caged reconstruction for metastatic acetabular disease would have a construct survival superior to that of their life expectancy. PATIENTS AND METHODS We undertook a retrospective study, in a single centre in the United Kingdom, reviewing outcomes for 19 patients (20 hips) treated with a cage reconstruction for metastatic disease of their acetabulum over 6 years. Inclusion criteria were those with an impending fracture of the acetabulum, metastatic dissociation, fracture of the acetabulum and or femur and those whose life expectancy was considered by the oncology team to be >6 months. RESULTS In all patients the Restoration GAP II acetabular cage (Stryker, Howmedica Osteonics Corp, NJ, USA) was used in conjunction with a cemented acetabular cup and cemented femoral stem. The mean age at the time of surgery was 68 (44-87) years with breast cancer being the most common primary malignancy (31%) followed by prostate cancer (26%).Radiological survivorship estimates were 94.1% (95% CI, 99.2-65.0) at 12 and 24 months, 70.6% (95% CI, 93.6-16.0) at 36 months and 35.3% (95% CI, 78.2-1.2) at 48 months. There were 3 radiological failures of the implant due to disease progression. Complications occurred in 3 patients with 2 developing deep infection which was treated with suppressive antibiotic therapy following aspiration of the hip. 1 patient suffered a hip dislocation following trauma which was successfully reduced closed and no further intervention was required. CONCLUSIONS This study represents the first published case series of the use of the GAP II cage in patients with metastatic acetabular disease. The construct generally outlives the patient and hence is suitable for the treatment of acetabular metastases.
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Affiliation(s)
- Sarah J Shiels
- Avon Orthopaedic Centre, North Bristol NHS Trust, Bristol, UK
| | - Oliver Gosling
- Avon Orthopaedic Centre, North Bristol NHS Trust, Bristol, UK
| | | | - Richard P Baker
- Avon Orthopaedic Centre, North Bristol NHS Trust, Bristol, UK
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Goriainov V, King LJ, Oreffo ROC, Dunlop DG. Custom 3D-Printed Triflange Implants for Treatment of Severe Acetabular Defects, with and without Pelvic Discontinuity: Early Results of Our First 19 Consecutive Cases. JB JS Open Access 2021; 6:JBJSOA-D-21-00057. [PMID: 34703963 PMCID: PMC8542159 DOI: 10.2106/jbjs.oa.21.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Treatment of massive acetabular defects, both with and without pelvic discontinuity, is challenging. The implants utilized in the surgical procedure need to be stable and integrate with poor host bone stock. In the present study, we describe our experience addressing this challenge.
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Affiliation(s)
- Vitali Goriainov
- Bone and Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Leonard J King
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Richard O C Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Douglas G Dunlop
- Bone and Joint Research Group, Centre for Human Development, Stem Cells & Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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32
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Rajkumar N, Soundarrajan D, Kumar PC, Dhanasekararaja P, Rajasekaran S. Clinical and Radiological Outcome of Acetabular Reconstruction Rings in Complex Primary and Revision Total Hip Arthroplasty. Indian J Orthop 2021; 55:1267-1276. [PMID: 34824728 PMCID: PMC8586132 DOI: 10.1007/s43465-021-00436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acetabular reconstruction in complex primary and revision total hip arthroplasty (THA) with bone loss poses a great challenge. We aim to evaluate the medium-term clinical and radiological outcome of reconstruction rings used in these difficult situations. METHODS We retrospectively reviewed a consecutive series of acetabular reconstructions with Muller ring or Bursh-Schneider cage from January 2009 to December 2016. The reconstruction rings were used in 66 hips (65 patients). There were 41 complex primary THA and 25 revision THA. The mean follow-up period was 76 months (range, 37-167 months). Clinical evaluation includes the assessment of Harris hip score, visual analogue scale (VAS) score, limb length discrepancy, and activities of daily living. The radiographs were analyzed for any signs of loosening, osteolysis, acetabular migration, and heterotopic ossification. RESULTS The overall survival rate was 95% for revision in aseptic loosening and 87% for any reason at an average follow-up of 6.3 years. Twelve patients died and 9 patients were lost to follow-up leaving 45 patients for final functional analysis. Among the 45 patients, excellent to good results were seen in 33 patients, fair results were seen in 5 patients, poor results were seen in seven patients. Two patients had aseptic loosening and another two patients developed deep chronic infection awaiting two-stage revision. CONCLUSION Reconstruction rings still place a role in the armamentarium for complex acetabular reconstruction. It helps to reliably restore the bone stock, have an acceptable survival rate and satisfactory functional outcome at medium to long-term follow-up.
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Abstract
Pelvic discontinuity (PD) has been a considerable challenge for the hip revision arthroplasty surgeon. However, not all PDs are the same. Some occur during primary cup insertion, resembling a fresh periprosthetic fracture that separates the superior and inferior portions of the pelvis, while others are chronic as a result of gradual acetabular bone loss due to osteolysis and/or acetabular implant loosening.In the past, ORIF, various types of cages, bone grafts and bone cement were utilized with little success. Today, the biomechanics and biology of PD as well as new diagnostic tools and especially a variety of new implants and techniques are available to hip revision surgeons. Ultraporous cups and augments, cup-cage constructs and custom triflange components have revolutionized the treatment of PD when used in various combinations with ORIF and bone grafts. For chronic PD the cup-cage construct is the most popular method of reconstruction with good medium-term results.Dislocation continues to be the leading cause of failure in all situations, followed by infection. Ultimately, surgeons today have a big enough armamentarium to select the best treatment approach. Case individualization, personal experience and improvisation are the best assets to drive treatment decisions and strategies. Cite this article: EFORT Open Rev 2021;6:459-471. DOI: 10.1302/2058-5241.6.210022.
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Affiliation(s)
- George C. Babis
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
| | - Vasileios S. Nikolaou
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
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Acetabular Insufficiency Fractures in the Setting of Graft vs Host Disease: A Report of Two Cases. Arthroplast Today 2021; 7:54-59. [PMID: 33521198 PMCID: PMC7818613 DOI: 10.1016/j.artd.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
We report a case series of 2 patients with unilateral acetabular insufficiency fractures who received allogeneic peripheral blood stem cell transplantation for hematologic malignancies complicated by chronic graft vs host disease. These were managed with uncemented cup and cage total hip arthroplasty and stabilization of posterior column with plating. Osteonecrosis of the acetabulum is an uncommon musculoskeletal complication of chronic graft vs host disease. The orthopedic impact of this disease should not be overlooked. Surgical intervention with this construct can provide necessary stability to improve patient function.
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35
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Changjun C, Xin Z, Mohammed A, Liyile C, Yue L, Pengde K. Survivorship and clinical outcomes of ‘cup–cage’ reconstruction in revision of hip arthroplasty for chronic pelvic discontinuity: A systematic review. Surgeon 2021; 19:e475-e484. [DOI: 10.1016/j.surge.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/13/2020] [Accepted: 11/26/2020] [Indexed: 12/27/2022]
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36
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Devlieger BK, Drees P, Mattyasovszky S, Özalp C, Rommens PM. Impingement of the Sciatic Nerve due to a Protruding Acetabular Cage Rim. Arthroplast Today 2020; 6:825-829. [PMID: 33024805 PMCID: PMC7529594 DOI: 10.1016/j.artd.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Sciatic nerve damage is a well-known complication that occurs in 1.5% of patients after primary total hip arthroplasty and in 8% after revision total hip arthroplasty. Yet when considering re-revision arthroplasty and acetabular cage implantation, incidence and management remain unclear. This case report describes a young female patient with sciatic nerve impingement after acetabular cage implantation. Her primary complaint was shooting sciatic left leg pain, worsening on ambulation and when seated. A complete workup was negative for spinal impingement or infection, and axonal nerve damage was confirmed through nerve conduction studies. The intraoperative findings showed that it was the acetabular cage rim that stretched the sciatic nerve. The rim was adjusted using a diamond burr to provide a specific solution without sacrificing the acetabular anchorage. Postoperative findings showed an excellent return to previous mobility and resolution of pain. This case provides a rare example of sciatic nerve impingement, showing that nerve palsies in the revision total hip arthroplasty setting may require patient-specific solutions.
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Affiliation(s)
- Benjamin Karel Devlieger
- Corresponding author. Department of Orthopedics and Traumatology, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany. Tel.: +491613117 7292.
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Frenzel S, Horas K, Rak D, Boelch SP, Rudert M, Holzapfel BM. Acetabular Revision With Intramedullary and Extramedullary Iliac Fixation for Pelvic Discontinuity. J Arthroplasty 2020; 35:3679-3685.e1. [PMID: 32694031 DOI: 10.1016/j.arth.2020.06.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Parallel to the increase in revision hip procedures surgeons face more and more complex anatomical challenges with pelvic discontinuity (PD) being one of the worst-case scenarios. Here we report on our clinical results using an asymmetric acetabular component for the treatment of PD. The implant is armed in a monoblock fashion with an extramedullary iliac flange and provides the possibility to augment it with an intramedullary iliac press-fit stem. METHODS In a single-center retrospective cohort study we analyzed prospectively collected data of 49 patients (35 female, 14 male) suffering from unilateral periprosthetic PD treated with an asymmetric acetabular component between 2009 and 2017. The mean follow-up was 71 months (21-114). Complications were documented and radiographic and functional outcomes were assessed. RESULTS Kaplan-Meier analysis revealed a 5-year implant survival of 91% (confidence interval 77%-96%). The 5-year survival with revision for any cause was 87% (CI 74%-94%). The overall revision rate was 16% (n = 8). Two patients required acetabular component revision due to aseptic loosening. Four patients (8%) suffered from periprosthetic infection: one patient was treated with a 2-stage revision, and another one with resection arthroplasty. The other 2 patients were treated with debridement, irrigation, and exchange of the mobile parts. Of 6 patients (12%) suffering from hip dislocation, 2 required implantation of a dual mobility acetabular component. The mean Harris Hip Score improved from 41 preoperatively to 79 at the latest follow-up (P < .001). CONCLUSION Our findings demonstrate that an asymmetric acetabular component with extramedullary and optional intramedullary iliac fixation is a reliable and safe treatment method for periprosthetic PD resulting in good clinical and radiographic mid-term results.
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Affiliation(s)
- Stephan Frenzel
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany; Department of Orthopaedics and Trauma Surgery, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Konstantin Horas
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Dominik Rak
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | | | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany; Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Szczepanski JR, Perriman DM, Smith PN. Surgical Treatment of Pelvic Discontinuity: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 7:e4. [PMID: 31503100 DOI: 10.2106/jbjs.rvw.18.00176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pelvic discontinuity is a rare condition that is treated with a range of implant constructs. However, surgical failure rates are high, and outcome data are inconsistent. It is therefore difficult to gain a clear picture of whether recently developed constructs (antiprotrusio cage [APC], cup-cage, custom triflange, and porous metal) provide better outcomes in terms of mechanical failure and complications in the short to long terms. This study investigated the failure and complication rates associated with cage constructs and porous metal technologies. METHODS A systematic review and meta-analysis were performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines to evaluate the studies showing pelvic discontinuity in revision total hip arthroplasty. Data retrieved included the intervention performed, length of follow-up, mechanical failure, and other complication rates (dislocation, infection, neurological, loosening, migration). Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) instrument. Pooled mechanical failure and complication rates were calculated using MetaXL 5.3. RESULTS None of the included 30 articles (n = 585 hips) were of high quality. The meta-analyses revealed a mechanical failure rate of 14% for all constructs combined. Custom triflange (5%) and cup-cage (7%) had the lowest mechanical failure rates compared with the commonly used APC (25%) and porous metal (12%). The overall other complication rate was 28%, with cup-cage lower at 21% compared with APC (34%) and custom triflange (28%). Long-term evidence investigating both interventions and porous metal technology is limited. CONCLUSIONS Mechanical failure rates for cup-cage and custom triflange were lowest. The other complication rate for cup-cage was lower than the pooled average. The study quality was limited, indicating a need for better studies and/or a registry. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jason R Szczepanski
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia
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Meynen A, Matthews H, Nauwelaers N, Claes P, Mulier M, Scheys L. Accurate reconstructions of pelvic defects and discontinuities using statistical shape models. Comput Methods Biomech Biomed Engin 2020; 23:1026-1033. [PMID: 32619099 DOI: 10.1080/10255842.2020.1784404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Treatment of large acetabular defects and discontinuities remains challenging and relies on the accurate restoration of the native anatomy of the patient. This study introduces and validates a statistical shape model for the reconstruction of acetabular discontinuities with severe bone loss through a two-sided Markov Chain Monte Carlo reconstruction method. The performance of the reconstruction algorithm was evaluated using leave-one-out cross-validation in three defect types with varying severity as well as severe defects with discontinuities. The two-sided reconstruction method was compared to a one-sided methodology. Although, reconstruction errors increased with defect size and this increase was most pronounced for pelvic discontinuities, the two-sided reconstruction method was able to reconstruct the native anatomy with higher accuracy than the one-sided reconstruction method. These findings can improve the preoperative planning and custom implant design in patients with large pelvic defects, both with and without discontinuities.
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Affiliation(s)
- Alexander Meynen
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Harold Matthews
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nele Nauwelaers
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Peter Claes
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Michiel Mulier
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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Mancino F, Cacciola G, Di Matteo V, De Marco D, Greenberg A, Perisano C, MA M, Sculco PK, Maccauro G, De Martino I. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8655. [PMID: 32913591 PMCID: PMC7459368 DOI: 10.4081/or.2020.8655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large "jumbo cups", oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Marco
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malahias MA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Wang CX, Huang ZD, Wu BJ, Li WB, Fang XY, Zhang WM. Cup-Cage Solution for Massive Acetabular Defects: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 12:701-707. [PMID: 32495512 PMCID: PMC7307242 DOI: 10.1111/os.12710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022] Open
Abstract
Our systematic review compiled multiple studies and evaluated survivorship and clinical outcomes of cup‐cage construct usage in the management of massive acetabular bone defects. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Various combinations of “acetabular”, “pelvis”, “cup cage” and their corresponding synonyms were used to search relevant articles in the Cochrane, EMBASE, and PubMed databases. Basic information of the functional scores, implant revision rate, and complication rate were selected as outcomes for analysis. Finally, a total of 11 articles published between 1999 and 2019 were selected, which include 232 patients with an average age of 68.5 years (range, 30–90). The mean follow‐up period was 48.85 months (range, 1–140). Our study shows that the cup‐cage construct has a good clinical outcome with a low revision rate and a low complication rate. Improved clinical outcomes of cup‐cage constructs were seen with a revision rate of 8% and an all‐cause complication rate of 20%. The most commonly reported complication was dislocation, followed by aseptic loosening, infection, and nerve injuries. In summary, it is a promising method for managing large acetabular bone defects in total hip revision.
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Affiliation(s)
- Chao-Xin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-da Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bai-Jian Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Fraile Suari A, Marqués López F, Cuenca Llavall M, Tey Pons M, León García A. Reconstruction for pelvic discontinuity and massive acetabular defects. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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43
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Cup-cage construct for massive acetabular defect in revision hip arthroplasty- A case series with medium to long-term follow-up. J Clin Orthop Trauma 2020; 11:62-66. [PMID: 32001986 PMCID: PMC6985017 DOI: 10.1016/j.jcot.2019.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/31/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Cup-cage reconstruction has emerged as a possible solution for managing massive acetabular defects with a few existing studies reporting encouraging results at mid-term follow-up. We present our experience with this unitised construct. METHOD Six patients (7 hips) with a mean age of 76 years (73-81) were revised due to catastrophic aseptic failure of a primary cup implanted 10-19 years previously, having a Paprosky type 3B acetabular defect. RESULTS At a mean follow-up of 72 months (63-140) no cases have required re-revision. Oxford Hip Scores improved from an average of 8 (1-17) preoperatively to an average of 36 (18-45) at the last follow-up. WOMAC scores preoperatively averaged 76 (49-96) and postoperatively averaged 26.5 points (0-69) at the last follow-up. SF-12 scores improved in both components. One patient showed non-progressive osteolysis around the ischial flange and one had less than 5 mm migration of the construct. One patient died of unrelated causes. CONCLUSION Our study presents one of the longest follow-up of cup-cage construct and supports the previously reported good results; it encourages the use of this construct in reconstruction of massive acetabular defect, with or without pelvic discontinuity.
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Tang H, Zhou B, Huang Y, Zhou Y, Chen B, Li X. Inferior extended fixation utilizing porous titanium augments improves primary anti-rotational stability of the acetabular component. Clin Biomech (Bristol, Avon) 2019; 70:158-163. [PMID: 31525656 DOI: 10.1016/j.clinbiomech.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The primary anti-rotational stability is critical to preventing cup tilting failure following revision total hip arthroplasty, but is frequently compromised by severe ischial bone loss. A novel technique of "inferior extended fixation" was introduced by securing a porous metal augment into the deficient ischium. This study evaluated the effect of this technique on primary anti-rotational stability in revision total hip arthroplasty. METHODS Composite hemipelvis specimens, acetabular components and "lotus" augments were used to simulate total hip arthroplasty surgeries. Three different cementless operative settings of cup implantation were simulated: (1) native ischium without defects; (2) ischium with a defect not reconstructed; (3) ischial defect reconstructed with inferior extended fixation using a lotus augment. Lever-out testing was used to examine primary anti-rotational stability, which was measured as interface stiffness and yield moment. FINDINGS Compared with the native ischium setting, the mean interface stiffness decreased by 53.1% in the ischial defect setting (p < 0.001). In the inferior extended fixation setting, the mean value was 110% greater than that in the ischial defect setting (p = 0.014), and comparable to that in the native ischium setting (p = 1). Similar results were observed for the yield moment (declined by 63.1%, p < 0.001; 200% higher, p < 0.001; and p = 0.395; respectively). INTERPRETATION In revision total hip arthroplasty with severe ischial defects, inferior extended fixation with a lotus porous titanium augment restores anti-rotational stability of the acetabular component to the level of that with a native ischium, which provides the mechanical environment for bone ingrowth and prevents cup tilting failure.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Baochun Zhou
- Department of Orthopaedics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China.
| | - Bo Chen
- R&D Center, AK Medical Co., Ltd, Beijing, China
| | - Xinyu Li
- R&D Center, AK Medical Co., Ltd, Beijing, China
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Xiao Q, Wang H, Zhou K, Wang D, Ling T, Pei F, Zhou Z. The mid-long term results of reconstructional cage and morselized allografts combined application for the Paprosky type III acetabular bone defects in revision hip arthroplasty. BMC Musculoskelet Disord 2019; 20:517. [PMID: 31699067 PMCID: PMC6839258 DOI: 10.1186/s12891-019-2915-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction. Methods We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation. Results All patients were followed up with a mean follow-up of 79.5 months (range 38–141), HHS improved from 31.4 (13–43) points preoperatively to 84.6 (55–94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. Conclusion The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.
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Affiliation(s)
- Qiang Xiao
- Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China.,Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Haoyang Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Duan Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Tingxian Ling
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedics, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China.
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Management of pelvic discontinuity in revision arthroplasty : Cementless acetabular cup with iliac stem and cranial strap. DER ORTHOPADE 2019; 48:413-419. [PMID: 30680468 DOI: 10.1007/s00132-018-03675-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pelvic discontinuity causes severe destruction of the acetabular bony walls and is particularly difficult to manage. This article reports the short-term results and complications encountered in the management of loosening of the acetabular cup with pelvic discontinuity using an acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate. MATERIAL AND METHODS As part of this monocentric retrospective case analysis all patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup with pelvic discontinuity in this clinic from January 2016 to June 2017 were identified (n = 16). All patients underwent routine clinical and radiological follow-up. In addition, the Harris hip score (HHS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated as part of a 1-year follow-up. RESULTS All patients were treated with an acetabular revision cup of appropriate size with intramedullary iliac stem combined with an anatomical extramedullary iliac plate. On clinical follow-up at 1 year (median follow-up time 14.5 ± 3.3 months), the average HHS was 69.3 ± 14.1 and the average WOMAC was 79.3 ± 11.7. Complications were registered in 7 out of the 16 patients whereby 1 showed aseptic loosening of the revision cup, dislocations were reported in 4 cases and infections in 2 cases. In the case of the two patients with infections a Girdlestone resection arthroplasty had to be performed. CONCLUSION The overall complications and postoperative outcome in revision surgery after THR reported in the literature were compared to the results of this study. Compared to the results of salvage procedures using large or bipolar heads and Girdlestone resection arthroplasty, satisfactory results were obtained using the acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate.
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Fraile Suari A, Marqués López F, Cuenca Llavall M, Tey Pons M, León García A. Reconstruction for pelvic discontinuity and massive acetabular defects. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:64-73. [PMID: 31543412 DOI: 10.1016/j.recot.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.
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Affiliation(s)
- A Fraile Suari
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España.
| | - Fernando Marqués López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - M Cuenca Llavall
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - M Tey Pons
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - A León García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
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Malhotra R, Gautam D. Cup-Cage Construct Using Porous Cup with Burch-Schneider Cage in the Management of Complex Acetabular Fractures. Hip Pelvis 2019; 31:87-94. [PMID: 31198775 PMCID: PMC6546672 DOI: 10.5371/hp.2019.31.2.87] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Cup-cage construct technique was developed to address the massive acetabular defects during revision hip arthroplasty. Indications have extended to complex acetabular fractures with pelvic discontinuity necessitating acute total hip arthroplasty. However, its use is constrained in low socioeconomic countries due to non-availability of the original cages from Trabecular Metal Acetabular Revision System and high cost. We used a novel technique using the less expensive Burch-Schneider (BS) cage and Trabecular Metal Revision Shell (TMRS) to address the problem. MATERIALS AND METHODS We reviewed a consecutive series of 8 cases of acetabular fractures reconstructed using a 'cup-cage construct' technique using a BS cage along with a TMRS. The mean age of the patients was 61.4 years. Patients were followed up for a mean period of 50.5 months (24 to 72 months). The patients were assessed clinically with Harris Hip Score and radiologically with serial X-rays. RESULTS All the patients were available at the latest follow up. The mean Harris Hip Score was 87.2. There was no radiological evidence of failure. One patient had dislocation two months following the surgery, which was treated by closed reduction and hip abduction brace. One patient developed an infection at 3 weeks necessitating debridement. The same patient had sciatic nerve palsy that recovered after 4 months. CONCLUSION This novel technique of the cup-cage construct seems to provide a stable construct at short to midterm follow-up. However, a long-term follow up would be required.
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Affiliation(s)
- Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS. Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg 2019; 103:1-13. [PMID: 29654551 DOI: 10.1007/s12306-018-0539-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 04/08/2018] [Indexed: 12/29/2022]
Abstract
Acetabular revision especially in the presence of severe bone loss is challenging. There is a paucity of literature critiquing contemporary techniques of revision acetabular reconstruction and their outcomes. The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal shells, uncemented revision jumbo shells, reinforced cages and rings, oblong shells and custom-made triflange constructs). Full-text papers and those with an abstract in English published from January 2001 to January 2016 were identified through international databases. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. Overall, patients had improved outcomes irrespective of the technique of reconstruction as documented by postoperative hip scores. Our pooled analysis suggests that oblong cups components had a lower failure rate compared with other different materials considered in this review. Custom-made triflange cups had one of highest failure rates. However, this may reflect the complexity of revisions and severity of bone loss. The most common postoperative complication reported in all groups was dislocation. This review confirms successful acetabular reconstructions using diverse techniques depending on the type of bone loss and highlights key features and outcomes of different techniques. In particular, oblong cups and tantalum shells have successful survivorship.
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Affiliation(s)
- A Volpin
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - S Konan
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - C Biz
- Department of Trauma and Orthopaedics, University of Padova, Padua, Italy
| | - R J Tansey
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Migaud H, Common H, Girard J, Huten D, Putman S. Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res 2019; 105:S53-S61. [PMID: 30138711 DOI: 10.1016/j.otsr.2018.04.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
Bone defects during acetabular revision of total hip arthroplasty raise a problem of primary fixation and of durable reconstruction. Bone graft with direct cemented fixation or in a reinforcement cage was long considered to be the gold standard; however, failures were reported after 10 years' follow-up, especially in segmental defect of the roof or pelvic discontinuity. In such cases, metallic materials were proposed, to ensure primary fixation by a roughness effect with added screws, and especially to avoid failure due to bone resorption in the medium term. We report a systematic literature analysis, addressing the following questions: (1) What materials are available and can be used with dual mobility (DM) designs? Apart from Trabecular Metal™ (TM), in which a DM cup can be cemented for sizes≥56mm, 4 other porous metals are available (Tritanium™, Trabecular Titanium™, Conceloc™, Regenerex™ and Gription™) although only the first 3 can be associated to DM. (2) Can the cost of these materials be estimated and compared to allograft with reinforcement cage? Considering simply the cost of the implant itself, compared to reconstruction by graft+cage+cemented cup (€2100), TM incurs an extra cost of €534, but with €1434 not covered by the French healthcare insurance. The cost of custom implants (apart from hemi-pelvis) ranges between €4200 and €8500, with only €4749 cover. (3) Do metallic materials ensure better survival than allograft+cage, according to severity of bone loss? Metallic reconstruction is claimed (with a low level of evidence) to reduce the risk of iterative loosening, but with a higher rate of dislocation, probably due to the lack of DM in many series. (4) What are the advantages and drawbacks of modular and custom metallic reconstructions? Modular reconstructions do not require 3D preoperative planning, but incur the risks of complications inherent to modularity. Custom implants can deal with more extensive defects, but require 5 to 8 weeks' production and are difficult to implant for the larger ones and/or when revision is limited to the acetabulum. (5) In what indications are these materials irreplaceable? Prior failure of allograft+cage in Paprosky type III defect with or without pelvic discontinuity shows the greatest benefit from metallic reconstruction, conditional on certain technical tricks. Only reconstructions using TM have more than 10 years' follow-up; other materials will need close monitoring. Failures in allograft with reinforcement cages occurred after about 10 years, and TM will need longer follow-up to prove its effectiveness. The high risk of dislocation should enable DM to be used, especially for small-diameter metallic reconstructions.
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Affiliation(s)
- Henri Migaud
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger Salengro, place de Verdun, centre hospitalier régional universitaire de Lille, 59037 Lille, France.
| | - Harold Common
- Service de chirurgie orthopédique, CHU de Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Julien Girard
- Université de Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, 59037 Lille, France
| | - Denis Huten
- Service de chirurgie orthopédique, CHU de Rennes-Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - Sophie Putman
- Université de Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital Roger Salengro, place de Verdun, centre hospitalier régional universitaire de Lille, 59037 Lille, France
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