Mid-term follow-up after all-size acetabular revision and proposal for a stability classification system

Clinical and radiological outcomes of jumbo cup in revision total hip arthroplasty: A systematic review

Introduction

Many studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA.

Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis.

Results

A total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm.

Conclusion

A jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.

Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity

BACKGROUND

Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery.

OBJECTIVE

The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA.

METHODS

Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant.

RESULTS

The average follow-up was 41.9 ± 34.8 months (range 1.5-120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure.

CONCLUSION

Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.

Monoflanged Custom-Made Acetabular Components Promote Biomechanical Restoration of Severe Acetabular Bone Defects by Metallic Defect Reconstruction

BACKGROUND

Custom-made acetabular components (CMAC) are one established method to address severe acetabular bone defects. Monoflanged CMAC may represent an advantageous alternative to establish triflanged CMAC as they promote better primary stability through metallic defect reconstruction and thus anatomic restoration of the center of rotation (COR).

METHODS

Fifty-eight consecutive (21 triflanged and 37 monoflanged) CMAC were evaluated for overall survival, reasons for revision, radiological restoration of COR, and clinical outcome parameters.

RESULTS

There were no significant differences between both design types regarding overall survival, revision rates, Harris Hip Score, or visual analog scale (pain) score at latest follow-up (mean, 56.3 ± 28.7 months). Triflanged CMAC showed a significant lateralization (P ≤ .001) and cranialization (P = .003) of the COR compared to the contralateral side. Monoflanged CMAC restored the anatomic COR. Reasons for revision surgery and explantation were periprosthetic joint infection (n = 12) and aseptic loosening (n = 2) without significant differences between both groups.

CONCLUSION

Monoflanged CMAC demonstrate similar clinical outcome parameters and survival rates as triflanged CMAC but superior biomechanical features and represent therefore a solid alternative treatment option and implant design.