1
|
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.
Collapse
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
| |
Collapse
|
2
|
Blackburn AZ, Mittal A, Velasco B, Baker C, Vandal NA, Tarabichi S, Humphrey TJ, Salimy MS, Courtney PM, Sheth NP, Bedair HS, Melnic CM. AAHKS Surgical Techniques & Technologies Award: Inferior Screw Fixation Decreases Acetabular Component Failure Following Revision Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00372-3. [PMID: 38649067 DOI: 10.1016/j.arth.2024.04.049] [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: 12/05/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Adjunctive screw fixation has been shown to be reliable in achieving acetabular component stability in revision total hip arthroplasty (THA). The purpose of this study was to assess the effect of inferior screw placement on acetabular component failure following revision THA. We hypothesized that inferior screw fixation would decrease acetabular failure rates. METHODS We reviewed 250 patients who had Paprosky Type II or III defects who underwent acetabular revision between 2001 and 2021 across three institutions. Demographic factors, the number of screws, location of screw placement (superior versus inferior), use of augments and/or cup-cage constructs, Paprosky classification, and presence of discontinuity were documented. Multivariate regression was performed to identify the independent effect of inferior screw fixation on the primary outcome of aseptic rerevision of the acetabular component. RESULTS At a mean follow-up of 53.4 months (range, 12 to 261), 16 patients (6.4%) required re-revision for acetabular loosening. There were 140 patients (56.0%) who had inferior screw fixation, all of whom did not have neurovascular complications during screw placement. Patients who had inferior screws had a lower rate of acetabular rerevision than those who only had superior screw fixation (2.1 versus 11.8%, P = .0030). Multivariate regression demonstrates that inferior screw fixation decreased the likelihood of rerevision for acetabular loosening when compared to superior screw fixation alone (odds ratio: 0.1, confidence interval: 0.03 to 0.5; P = .0071). No other risk factors were identified. CONCLUSIONS Inferior screw fixation is a safe and reliable technique to reduce acetabular component failure following revision THA in cases of severe acetabular bone loss.
Collapse
Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Ashish Mittal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Brian Velasco
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colin Baker
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Nicholas A Vandal
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Tyler J Humphrey
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Neil P Sheth
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| |
Collapse
|
3
|
Mirghaderi P, Eshraghi N, Sheikhbahaei E, Razzaghof M, Roustai-Geraylow K, Pouramini A, Eraghi MM, Kafi F, Javad Mortazavi SM. Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 25:101293. [PMID: 38298809 PMCID: PMC10827600 DOI: 10.1016/j.artd.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 02/02/2024] Open
Abstract
Background Studies suggest tantalum (Ta) implants may have inherent antibacterial properties. However, there is no consensus regarding the effectiveness of Ta in preventing periprosthetic joint infection (PJI) after revision total hip arthroplasty (rTHA). Methods We searched 5 main databases for articles reporting the rate of PJI following rTHA using Ta implants from inception to February 2022. The PJI rates of the Ta group were meta-analyzed, compared with the control group, and represented as relative risks (RRs) in forest plots. Results We identified 67 eligible studies (28,414 joints) for assessing the prevalence of PJI following rTHA using Ta implants. Among these studies, only 9 compared the Ta implant group with a control group. The overall PJI rate following rTHA using Ta implants was 2.9% (95% confidence interval [CI]: 2.2%-3.8%), while it was 5.7% (95% CI = 4.1%-7.8%) if only septic revisions were considered. Comparing the Ta and control groups showed a significantly lower PJI rate following all-cause rTHA with an RR = 0.80 (95% CI = 0.65-0.98, P < .05). There was a trend toward lower reinfection rates in the Ta group after rTHA in septic cases, although the difference was not statistically significant (RR = 0.75, 95% CI = 0.44-1.29, P = .30). Conclusions Ta implants are associated with a lower PJI rate following all-cause rTHA but not after septic causes. Despite positive results, the clinical significance of Ta still remains unclear since the PJI rate was only reduced by 20%. Level of Evidence IV.
Collapse
Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Roustai-Geraylow
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kafi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
4
|
Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
Collapse
Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| |
Collapse
|
5
|
Humphrey TJ, Baker CM, Courtney PM, Paprosky WG, Bedair HS, Sheth NP, Melnic CM. The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes. Hip Pelvis 2023; 35:122-132. [PMID: 37323551 PMCID: PMC10264228 DOI: 10.5371/hp.2023.35.2.122] [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: 12/07/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.
Collapse
Affiliation(s)
- Tyler J. Humphrey
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Colin M. Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul M. Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Wayne G. Paprosky
- Department of Orthopaedic Surgery, Section of Adult Joint Reconstruction, Rush Presbyterian-St. Luke’s Medical Center, Chicago, IL, USA
| | - Hany S. Bedair
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Neil P. Sheth
- Pennsylvania Hospital, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher M. Melnic
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Melnic CM, Salimy MS, Hosseinzadeh S, Moverman MA, Bedair HS, Lozano-Calderón SA, Raskin KA. Trabecular metal augments in severe malignancy-associated acetabular bone loss. Hip Int 2022:11207000221110787. [PMID: 35815407 DOI: 10.1177/11207000221110787] [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
INTRODUCTION Acetabular reconstruction is a challenging problem in orthopaedic oncology, especially in extended defects (Paprosky Type 3A and Type 3B). In revision total hip arthroplasty (THA), 1 option is trabecular metal (TM) augments with a porous metal acetabular component. This study evaluated the use of TM augments in periacetabular malignant bone disease. METHODS 15 patients were identified from our institutional database from 2000 to 2020 with either Paprosky Type 3A or Type 3B acetabular bone loss due to periacetabular malignancies that underwent at least 1 complex THA reconstruction with TM augments. Postoperative complications were documented, and clinical and radiographic outcomes were analysed. Radiological loosening or revision of the acetabular component were defined as endpoints. RESULTS There were 7 primary and 8 metastatic cancer patients. 5 were Type 3A and 10 were Type 3B defects after tumour resection. The average follow-up time was 23.8 (range 1.5-47) months. 1 patient required revision for acetabular component loosening after 7 months from the initial implantation. An additional 4 patients required surgical intervention for infection, they had stable TM augments at latest follow-up. CONCLUSION TM augments with a porous metal acetabular component may be an alternative to the traditional cemented constructs.
Collapse
Affiliation(s)
- Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Michael A Moverman
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin A Raskin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Tripolar Constrained and Dual Mobility Liners Are Both Successful When Cemented Into Tantalum Acetabular Revision Shells in Complex Revision Total Hip Arthroplasty. Arthroplast Today 2022; 14:53-58. [PMID: 35242957 PMCID: PMC8881686 DOI: 10.1016/j.artd.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/19/2021] [Accepted: 12/30/2021] [Indexed: 12/04/2022] Open
Abstract
Background Instability is a common complication after revision total hip arthroplasty. Tripolar constrained (TC) and dual mobility (DM) liners cemented into tantalum acetabular revision (TM) shells are established alternatives that reduce instability risk. This study compares outcomes of TC and DM liners cemented into TM shells in complex revision hip replacements. Methods Fifty cases using a TM shell and a TC or DM cemented liner with at least 12 months of follow-up were identified. There were 25 TC and 25 DM liners. Clinical, radiographic, and patient-reported outcomes were collected. Reasons for re-revision and failures were analyzed. Results The average age was 73 years in the TC group and 75 years in the DM group. The median follow-up duration was 50 months (23 - 96) and 13 months (12 – 21) for the TC and DM groups, respectively. The mean Harris Hip Score improved from 37 to 61 for the TC group and from 51 to 73 in the DM group at the last review. Two TC cases required revision for wear and liner failure. One DM insert was changed at reoperation for periprosthetic femur fracture. There were no failures of cement fixation in either group and no revisions for cup loosening. Conclusions In complex revision hip replacement with a history of instability or judged to have a high risk of instability postoperatively, TC and DM liners cemented into tantalum revision shells are both successful, giving acceptable results. The improved arc of movement with DM liners, minimizing impingement, makes them preferable except when there is a global abductor deficiency or severe joint laxity.
Collapse
|
9
|
Malahias MA, Mancino F, Gu A, Adriani M, De Martino I, Boettner F, Sculco PK. Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review. Hip Int 2022; 32:185-196. [PMID: 33147103 DOI: 10.1177/1120700020971851] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In conjunction with impaction bone grafting (IBG), metal meshes have been proposed to minimise defects of the medial and superolateral walls in order to convert combined complex uncontained segmental defects into contained cavitary defects to facilitate IBG. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to March 2019 utilising keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting, clinical or functional outcomes, revision THA, or postoperative complications. RESULTS 7 articles were found to be suitable for inclusion in the present study. The mean modified Coleman methodology score for methodological deficiencies of the studies was 45.3 (range 38-59). Severe acetabular bone loss was present in 56% of cases having moderate bone loss in 18%, and mild in 26%. The all-cause reoperation rate was 7.4%, while the all-cause revision rate of the acetabular component was 6.2%. CONCLUSIONS IBG with mesh is effective for selected patients with acetabular bone defects. Most patients with moderate bone loss as well as selected patients with large superolateral defects can be successfully treated with IBG combined with mesh. There is limited data to show that IBG with mesh might be associated with decreased survival rates in patients with severe lateral defects (Paprosky IIIA) combined with ischial or medial wall osteolysis who require combined medial and lateral meshes. In addition, patients with severe superomedial migration of the cup (Paprosky IIIB) should not be treated with IBG and mesh.
Collapse
Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Fabio Mancino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Marco Adriani
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Ivan De Martino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Friedrich Boettner
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, USA
| |
Collapse
|
10
|
Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
Collapse
Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hip and Knee Replacement. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1007/978-3-030-78529-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
12
|
Long-term results of combined porous tantalum augments and titanium-coated cups for Paprosky type III bone defects in acetabular revision. INTERNATIONAL ORTHOPAEDICS 2021; 45:1699-1706. [PMID: 34019127 DOI: 10.1007/s00264-021-05075-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The use of porous tantalum augments and titanium-coated cups in primary total hip arthroplasty (THA) with acetabular defects has shown satisfactory outcomes in our centre. The aim of this study was to report the long-term radiological and clinical outcomes of using this combination for Paprosky type III acetabular bone defects in acetabular revision. PATIENTS AND METHODS Between January 2007 and January 2015, 45 patients with Paprosky type III acetabular defects underwent acetabular revision using a combination of porous tantalum augments and titanium-coated cups. Among these, 41 patients (41 hips) had complete follow-up. Thirty-one patients had a Paprosky type IIIA defect, and ten patients had a Paprosky type IIIB defect. No patients had pelvic discontinuity. There were 20 males and 21 females with an average age of 63.2 years (range 35-80) at the time of revision surgery. RESULTS The mean follow-up was 122.8 months (range 69-165). The Harris Hip Score (HHS) improved significantly from 32.1 points (range 17-58) pre-operatively to 85.3 points (63-98) at the last follow-up. The Short Form-12 (SF-12) and Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) improved significantly for each item at the last follow-up. Two patients had a high hip centre post-operatively. One patient had recurrent dislocation but did not require re-revision. No further revision of the acetabular components was required, and all hips remained stable at the last follow-up with bony ingrowth of the acetabular components according to the criteria of Moore et al. CONCLUSION: The combination of tantalum augments and conventional titanium-coated cups achieved satisfactory long-term radiographic and clinical outcomes for Paprosky type III acetabular bone defects without pelvic discontinuity.
Collapse
|
13
|
Russell SP, O'Neill CJ, Fahey EJ, Guerin S, Gul R, Harty JA. Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow-Up. J Arthroplasty 2021; 36:1740-1745. [PMID: 33468343 DOI: 10.1016/j.arth.2020.12.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases. METHODS 38 patients underwent revision total hip arthroplasty at our institution from 2009 to 2014 where a TM augment was used for acetabular deficiency. Prospective radiographic and Patient-Reported Outcome Measures were recorded and analyzed to a mean of 7.3 years (range: 5.4 to 10.8). RESULTS No patient was excluded or lost to follow-up. Complications included 3 intraoperative fractures, 1 early infection requiring washout with implant retention, 1 early revision due to allograft resorption, and 6 patients who required late repeat revision surgery: 3 for late infection, 2 for aseptic loosening with augment fracture or dislocation, and 1 for recurrent dislocation. The estimated mean implant survivorship was 8.99 years. 93.5% of augments remaining were well osseointegrated while 97% of the acetabular shells were osseointegrated. Hip center of rotation was restored by a mean of 14 mm inferiorly without significant medialization. Short Form-12 (SF-12) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were significantly reduced postoperatively to a level comparable to the average individual. CONCLUSION This long-term study details our experience of TM augments for the most severe acetabular defects. For such cases, no excellent surgical solution exists; in comparison to alternative methods, we advocate that this technique is reasonably safe and effective.
Collapse
Affiliation(s)
- Shane P Russell
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cathleen J O'Neill
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoin J Fahey
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shane Guerin
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
| | - Rehan Gul
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
| | - James A Harty
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
| |
Collapse
|
14
|
The Dome Technique, an Option for Massive Anterosuperior Medial Acetabular Bone Loss: A Retrospective Case Series. HSS J 2020; 16:521-526. [PMID: 33380991 PMCID: PMC7749926 DOI: 10.1007/s11420-019-09730-x] [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: 02/03/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular bone loss in revision total hip arthroplasty can be very challenging even for fellowship-trained surgeons. Although it is uncommon, massive anterosuperior medial defects may be encountered, but treatment options have been limited and better ones are needed. QUESTIONS/PURPOSES The primary purpose of this case series is to describe a novel surgical treatment, which we call the dome technique, that can be used to address these challenging defects. The dome technique allows for the systematic reconstruction of massive anterosuperior medial defects of the acetabulum. We sought to illustrate the utility of this procedure in three patients with failed acetabular components and massive anterosuperior medial defects. METHODS We undertook a retrospective chart review of three patients who had had Paprosky 3B bone defects and undergone revision total hip arthroplasty by the senior author between 2013 and 2016 using the dome technique. The procedure involved the use of tantalum metal augments pieced together to fill the medial defect and recreate the column support needed for jumbo cup placement. The dome technique is unusual because it allows for intra-operative customization to obtain the proper fit. RESULTS At a mean of 23.6 months' follow-up (range, 10 to 37 months), all patients had good functional outcomes; none was in need of further revision. CONCLUSIONS In three patients, the dome technique allowed for the anterosuperior column to be recreated by piecing together two porous metal augments to fill the medial bony void and create a stable column for a jumbo cup to be press fit. By recreating the deficient anterosuperior medial bone, the acetabulum can be downsized in a stepwise manner (with further surgery) and reconstructed in a stable fashion. This novel procedure is a unique option for the treatment of this challenging problem.
Collapse
|
15
|
Stemmed acetabular cup as a salvage implant for revision total hip arthroplasty with Paprosky type IIIA and IIIB acetabular bone loss. Orthop Traumatol Surg Res 2020; 106:589-596. [PMID: 32265174 DOI: 10.1016/j.otsr.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Certain cases of repeated acetabular loosening with severe bone loss are hardly amenable to reconstruction using a Kerboull-type plate with allograft. This limitation is more likely when the severe bone loss occurs in older adults with significant comorbidities that may require a faster procedure. In these indications, a stemmed acetabular cup may be an alternative, although the outcomes have not been well defined, especially for a version where the peg is coated with porous material and additional screws can be added. This led us to conduct a retrospective study to determine: (1) whether a stemmed cup anchored in the iliac isthmus is a viable alternative in these situations, (2) the complication rate and (3) the revision rate for any reason. HYPOTHESIS A stemmed cup anchored in the iliac isthmus is a viable alternative in cases of repeated revision with severe acetabular bone loss. MATERIALS AND METHODS We performed a retrospective single-center study. Sixteen Integra™ cups were implanted in 14 patients (mean age 72.8±10.4 years, minimum-maximum: 58-95) who had aseptic acetabular loosening combined with severe acetabular bone loss graded as Paprosky IIIA in 7 hips and IIIB in 9 hips. The patients had undergone a mean of 2.7±1.8 (minimum-maximum: 1-6) procedures (i.e. primary and/or revision arthroplasty) before this cup was implanted. The cup's survivorship at the time of review and the complication rate were determined. RESULTS At a mean follow-up of 48.8±23.4 months (minimum-maximum: 7-85), two patients had died and two were lost to follow-up. Six hips experienced one or more complications (37.5%): three infections (18.8%), two mechanical failures (12.5%) and one dislocation (6.7%). The cup had to be removed in three patients (18.8%). These complications required reoperation, thus the cumulative incidence of revision for any reason at 5 years was 31% (95% CI: 11-55%). CONCLUSION Despite the high complication and revision rates, we believe the stemmed acetabular cup is a viable alternative in salvage reconstruction procedures. LEVEL OF EVIDENCE IV, Retrospective case study.
Collapse
|
16
|
Du YQ, Liu YP, Sun JY, Ni M, Zhou YG. Reconstruction of Paprosky type IIIB acetabular bone defects using a cup-on-cup technique: A surgical technique and case series. World J Clin Cases 2020; 8:1223-1231. [PMID: 32337196 PMCID: PMC7176610 DOI: 10.12998/wjcc.v8.i7.1223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paprosky type IIIB acetabular bone defects are very difficult to reconstruct. For severe defects, we developed our own cup-on-cup technique. We defined the tantalum metal (TM) revision shell with the peripheral titanium ring removed as a TM-cup augment and the cementless hemispherical acetabulum component combined with a TM-cup augment as the cup-on-cup technique.
AIM To report the short-term results of patients with type IIIB acetabular bone defects reconstructed using the cup-on-cup technique.
METHODS We retrospectively reviewed six patients (six hips) with a mean age of 59 years who underwent acetabular reconstruction using our cup-on-cup technique between January 2015 and January 2017. All acetabular bone defects were classified as type IIIB without pelvic discontinuity using the system of Paprosky. All patients were followed both clinically and radiographically for a mean duration of 42 mo.
RESULTS The mean Harris hip score improved from 32.4 pre-operatively to 80.7 at the last follow-up. The mean vertical position of the hip rotation centre changed from 60.9 mm pre-operatively to 31.7 mm post-operatively, and the mean horizontal position changed from 33.6 mm pre-operatively to 38.9 mm post-operatively. Greater trochanteric migration after extended trochanteric osteotomy occurred in one of six hips at 3 mo. There was no evidence of component migration at the last follow-up.
CONCLUSION The short-term results suggest that our cup-on-cup technique could be considered an effective management option for Paprosky type IIIB acetabular bone defects without pelvic discontinuity.
Collapse
Affiliation(s)
- Yin-Qiao Du
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yu-Ping Liu
- Department of Orthopedics, Tengzhou Central People’s Hospital, Tengzhou 277500, Shandong Province, China
| | - Jing-Yang Sun
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ming Ni
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yong-Gang Zhou
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| |
Collapse
|
17
|
Mussa M, Dewan V, Isbister E. Two stage cementation and screw augmentation of large acetabular defects in low demand patients: Early results and surgical technique. J Orthop 2020; 18:23-27. [PMID: 32189878 PMCID: PMC7068009 DOI: 10.1016/j.jor.2019.09.002] [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: 12/08/2018] [Revised: 07/27/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The reconstruction of large acetabular defects in revision hip arthroplasty represents a challenge to the surgeon and increases the complexity of the case. There are different options to overcome the problem of acetabular deficiency. In the elderly low demand patients, the main objective of revision surgery is to provide pain relief, allow immediate full weight bearing, and an early return to function. METHODS This article presents our experience in acetabular revision surgery using a novel technique of two stage cementation and screw augmentation in low demand patients. We report on the surgical technique and present the early results in 10 patients. RESULTS There were 6 females and 4 males with average age of 83.8 years. Patients were followed up for an average of 18.1 months. All patients were pain free and full weight bearing at the time of the final follow up with radiographs showing maintenance of implant position. None of the patients underwent revision surgery and there were no radiographic signs of failure detected in the early follow-up period. CONCLUSION This is a suitable technique in the management of large acetabular defects in revision hip arthroplasty, especially in the low demand patient population. It is a simple cost-effective technique that reduces the complexity of the acetabular revision, operative time, and morbidity associated with prolonged complex revision surgery.
Collapse
Affiliation(s)
- Mohamed Mussa
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | | |
Collapse
|
18
|
Eachempati KK, Malhotra R, Pichai S, Reddy AVG, Podhili Subramani AK, Gautam D, Bollavaram VR, Sheth NP. Results of trabecular metal augments in Paprosky IIIA and IIIB defects. Bone Joint J 2018; 100-B:903-908. [DOI: 10.1302/0301-620x.100b7.bjj-2017-1604.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky IIIA and IIIB defects. Patients and Methods A retrospective study was conducted at four centres between August 2008 and January 2015. Patients treated with TM augments and TM shell for a Paprosky grade IIIA or IIIB defect, in the absence of pelvic discontinuity, and who underwent revision hip arthroplasty with the use of TM augments were included in the study. A total of 41 patients with minimum follow-up of two years were included and evaluated using intention-to-treat analysis. Results There were 36 (87.8%) patients with a Paprosky IIIA defect and five (12.2%) patients with a Paprosky IIIB defect. The mean age was 56.7 years (28 to 94). There were 21 (51.2%) women and 20 (48.8%) men. The mean follow-up was 39.4 months (12 to 96). One (2%) patient died after eight years. No failures were noted in the series. The mean survivorship was 100% at the time of latest follow-up. Conclusion The results of this multicentre study showed encouraging short- and mid-term results for the use of TM augments in the management of Paprosky grade IIIA and IIIB defects. Cite this article: Bone Joint J 2018;100-B:903–8.
Collapse
Affiliation(s)
- K. K. Eachempati
- Department of Orthopaedics, Max Cure Hospitals, Hyderabad, India
| | - R. Malhotra
- Department of Orthopaedics, All India
Institute of Medical Sciences, New Delhi, India
| | - S. Pichai
- Asian Joint Reconstruction Institute, Chennai, India
| | | | | | - D. Gautam
- Department of Orthopaedics, All India
Institute of Medical Sciences, New Delhi, India
| | - V. R. Bollavaram
- Department of Orthopaedics, Max Cure Hospitals, Hyderabad, India
| | - N. P. Sheth
- Department of Orthopaedic Surgery, University
of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Gibon E, Barut N, Courpied JP, Hamadouche M. Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum: a minimum five-year follow-up study. Bone Joint J 2018; 100-B:725-732. [PMID: 29855248 DOI: 10.1302/0301-620x.100b6.bjj-2017-1472.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d'Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d'Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725-32.
Collapse
Affiliation(s)
- E Gibon
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | - N Barut
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | - J-P Courpied
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| | - M Hamadouche
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedics Research Center, Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France
| |
Collapse
|
20
|
O'Neill CJ, Creedon SB, Brennan SA, O'Mahony FJ, Lynham RS, Guerin S, Gul R, Harty JA. Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects. J Arthroplasty 2018; 33:823-828. [PMID: 29217393 DOI: 10.1016/j.arth.2017.10.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/07/2017] [Accepted: 10/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trabecular Metal (TM) augments are one option when reconstructing bone loss during acetabular side revision surgery. METHODS We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a TM shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at the time of surgery was 68.2 years (range 48-84). The mean length of follow-up was 36 months (range 18-74). RESULTS The mean preoperative short form 12 health survey improved from 27.7 before operation to 30.1 at the time of final follow-up (P = .001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 53 preoperatively to a mean of 78.8 at final follow-up (P < .0001). There was evidence of radiographic loosening in 7 of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening. CONCLUSION The use of TM in complex acetabular reconstruction is associated with good outcome in the short to medium term.
Collapse
Affiliation(s)
- Cathleen J O'Neill
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Stephen B Creedon
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Stephen A Brennan
- Department of Orthopaedic Surgery, Bon Secours Hospital, Cork, Ireland
| | - Fiona J O'Mahony
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Rosanne S Lynham
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Shane Guerin
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Rehan Gul
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - James A Harty
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| |
Collapse
|
21
|
Ling TX, Li JL, Zhou K, Xiao Q, Pei FX, Zhou ZK. The Use of Porous Tantalum Augments for the Reconstruction of Acetabular Defect in Primary Total Hip Arthroplasty. J Arthroplasty 2018; 33:453-459. [PMID: 29033154 DOI: 10.1016/j.arth.2017.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Given the lack of studies of acetabular defect reconstruction in primary total hip arthroplasty (THA) using tantalum augments, this study aims to evaluate clinical and radiographic results for treatment with tantalum augments to reconstruct acetabular defects in primary THA. METHODS We retrospectively reviewed 19 patients (19 hips) with acetabular defects who underwent primary THA using tantalum augments, with a minimum follow-up of 2 years. Clinical, radiographic, and surgical data were retrospectively evaluated. RESULTS Mean follow-up was 5.1 years (range 2.5-7.6). Harris Hip Score improved from 35.8 (range 19-56) preoperatively to 85.3 (63-98) at last follow-up (P < .01). Oxford Hip Score, University of California Los Angeles activity scale, and Short Form-12 score also improved significantly from presurgery to last follow-up. Mean operation time and blood loss were 124.7 minutes and 530 mL, respectively. Mean hip center position was 2.97 cm (range 2.35-3.58) horizontally and 2.06 cm (1.29-2.92) vertically, and mean acetabular inclination was 38.9° (range 27°-47°) at last follow-up. These parameters were not significantly different from those recorded immediately postoperatively (P > .05). There was no aseptic loosening, cup and augment migration, screw breakage, or presence of hip infection at last follow-up. All hips were radiographically stable. CONCLUSION Porous tantalum augments combined with titanium shells lead to satisfactory clinical and radiographic outcomes for the reconstruction of acetabular defect in primary THA at a mean 5.1 years of follow-up. This approach confers anatomical cup placement, simple operation, and a high rate of stable fixation.
Collapse
Affiliation(s)
- Ting-Xian Ling
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jin-Long Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qiang Xiao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| |
Collapse
|
22
|
Abstract
The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.
Collapse
Affiliation(s)
- Young-Ho Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| |
Collapse
|
23
|
Abrahams JM, Kim YS, Callary SA, De Ieso C, Costi K, Howie DW, Solomon LB. The diagnostic performance of radiographic criteria to detect aseptic acetabular component loosening after revision total hip arthroplasty. Bone Joint J 2017; 99-B:458-464. [DOI: 10.1302/0301-620x.99b4.bjj-2016-0804.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/08/2016] [Indexed: 12/31/2022]
Abstract
Aims This study aimed to determine the diagnostic performance of radiographic criteria to detect aseptic acetabular loosening after revision total hip arthroplasty (THA). Secondary aims were to determine the predictive values of different thresholds of migration and to determine the predictive values of radiolucency criteria. Patients and Methods Acetabular component migration to re-revision was measured retrospectively using Ein-Bild-Rontgen-Analyse (EBRA-Cup) and manual measurements (Sutherland method) in two groups: Group A, 52 components (48 patients) found not loose at re-revision and Group B, 42 components (36 patients) found loose at re-revision between 1980 and 2015. The presence and extent of radiolucent lines was also assessed. Results Using EBRA, both proximal translation and sagittal rotation were excellent diagnostic tests for detecting aseptic loosening. The area under the receiver operating characteristic (ROC) curves was 0.94 and 0.93, respectively. The thresholds of 2.5 mm proximal translation or 2° sagittal rotation (EBRA) in combination with radiolucency criteria had a sensitivity of 93% and specificity of 88% to detect aseptic loosening. The sensitivity, specificity, positive predictive value and negative predictive value (NPV) of radiolucency criteria were 41%, 100%, 100% and 68% respectively. Manual measurements of both proximal translation and sagittal rotation were very good diagnostic tests. The area under the ROC curve was 0.86 and 0.92 respectively. However, manual measurements had a decreased specificity compared with EBRA. Radiolucency criteria had a poor sensitivity and NPV of 41% and 68% respectively. Conclusion This study shows that EBRA and manual migration measurements can be used as accurate diagnostic tools to detect aseptic loosening of cementless acetabular components used at revision THA. Radiolucency criteria should not be used in isolation to exclude loosening of cementless acetabular components used at revision THA given their poor sensitivity and NPV. Cite this article: Bone Joint J 2017;99-B:458–64.
Collapse
Affiliation(s)
- J. M. Abrahams
- Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
and PhD Candidate, Discipline of Orthopaedics
and Trauma, The University of Adelaide, Adelaide, SA, Australia
| | - Y. S. Kim
- Dongguk University Gyeongju Hospital, Gyeongju, Gyeongsangbuk-do, South
Korea
| | - S. A. Callary
- Royal Adelaide Hospital, Level
4 Bice Building, Royal Adelaide Hospital, North
Terrace, Adelaide, SA, Australia
and Discipline of Orthopaedics and Trauma, University
of Adelaide, Adelaide, SA, Australia
| | | | - K. Costi
- Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
| | - D. W. Howie
- The University of Adelaide, Adelaide, SA, Australia
and Clinical Director, Department of Orthopaedics and
Trauma, Royal Adelaide Hospital, Level
4 Bice Building, North Terrace, Adelaide, SA, Australia
| | - L. B. Solomon
- The University of Adelaide, Adelaide, SA, Australia
and Orthopaedic Consultant, Department of Orthopaedics
and Trauma, Royal Adelaide Hospital Level 4
Bice Building, North Terrace, Adelaide, SA, Australia
| |
Collapse
|
24
|
Cadossi M, Garcia FL, Sambri A, Andreoli I, Dallari D, Pignatti G. A 2- to 7-Year Follow-Up of a Modular Iliac Screw Cup in Major Acetabular Defects: Clinical, Radiographic and Survivorship Analysis With Comparison to the Literature. J Arthroplasty 2017; 32:207-213. [PMID: 27449716 DOI: 10.1016/j.arth.2016.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inadequate acetabular bone stock is a major issue in total hip arthroplasty, and several treatment options are available. Stemmed cups have been used in this scenario with variable results. A novel modular polyaxial uncemented iliac screw cup (HERM-BS-Sansone cup-Citieffe s.r.l., Calderara di Reno, Bologna, Italy) has been recently introduced to overcome the drawbacks of stemmed cups. In this retrospective study, we report the results of this cup in patients with large acetabular bone defects at 2- to 7-year follow-up. METHODS We evaluated a consecutive series of 121 hips (118 revisions and 3 complex primary arthroplasties) treated with this novel cup at a mean follow-up of 46 months. Kaplan-Meier survival analysis was performed with implant revision for any reason as a primary end point. Further survival analysis was performed excluding septic failures. Clinical outcome was assessed with the Harris Hip Score. RESULTS There had been 7 reoperations: 1 for aseptic loosening, 5 for deep infection, and 1 for recurrent dislocation. In 5 cases, the cup was removed; estimated survival rate at 5-year follow-up with implant removal for any reason was 95.6% (95% confidence interval = 91-99), and 98.3% (95% CI = 96-100) excluding those failed for infection. Mean Harris Hip Score at latest follow-up was 77 points (range, 44-95; standard deviation = 11.9). CONCLUSION The present findings show the short-term efficacy of the iliac screw cup with respect to implant survival. A longer follow-up and a larger number of patients are necessary to confirm the encouraging preliminary results.
Collapse
Affiliation(s)
| | - Flávio Luís Garcia
- Ribeirão Preto Medical School (University of São Paulo), Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
25
|
Ivaldo N, Mangano T, Caione G, Rossoni M, Ligas A. Customized tantalum-augmented reverse shoulder arthroplasty for glenoid bone defect and excessive medialization: description of the technique. Musculoskelet Surg 2016; 100:13-18. [PMID: 27900710 DOI: 10.1007/s12306-016-0404-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Glenoid bone defect and excessive medialization could represent challenging issues during reverse shoulder arthroplasty, especially in the setting of revision surgery. Although a solution is offered by the Boileau's BIO-RSA technique in primary cases, only autologous iliac crest bone graft and homologous graft from bone banks are available for revision surgeries, with known disadvantages and risk of graft resorption and implant failure. MATERIALS AND METHODS We describe in this work a new technique based on a customized porous tantalum device to be used in salvage situations, aimed at lateralization of the glenoid component of a reverse shoulder arthroplasty. Between 2014 and 2015, five patients received a customized tantalum-augmented RSA at our institution. The augments we applied are actually on the market for acetabular bone loss management: these were opportunely prepared and fixed to the metal back of the glenoid component before implantation. RESULTS In the five cases treated, no major or minor complications have been recorded to date. Despite the short follow-up, all the implants are still in situ. All of the patients referred complete subjective satisfaction and return to their daylife activities without pain within 4 months after surgery. CONCLUSIONS The customized tantalum-augmented RSA technique represents in our experience a useful and safe solution in managing glenoid bone loss and medialization. Adaptability to virtually every device in the market should be regarded as important point of strength of this technique.
Collapse
Affiliation(s)
- Nicola Ivaldo
- Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy
- Casa di Cura Villa Igea, Acqui Terme, Italy
| | - Tony Mangano
- Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy.
- Casa di Cura Villa Igea, Acqui Terme, Italy.
| | - Giovanni Caione
- Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy
- Casa di Cura Villa Igea, Acqui Terme, Italy
| | - Mario Rossoni
- Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy
- Casa di Cura Villa Igea, Acqui Terme, Italy
| | - Angelo Ligas
- Shoulder Surgery Unit, Gruppo Sanitario Ligure (GSL) c/o Ospedale S.M. di Misericordia, Viale Martiri della Foce, n. 40, 17031, Albenga, SV, Italy
| |
Collapse
|
26
|
Baauw M, van Hooff ML, Spruit M. Current Construct Options for Revision of Large Acetabular Defects. JBJS Rev 2016; 4:01874474-201611000-00002. [DOI: 10.2106/jbjs.rvw.15.00119] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
27
|
Gu Q, Zhu H, Li J, Li X, Hao J, Wallace GG, Zhou Q. Three-dimensional bioprinting speeds up smart regenerative medicine. Natl Sci Rev 2016. [DOI: 10.1093/nsr/nww037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Biological materials can actively participate in the formation of bioactive organs and can even control cell fate to form functional tissues that we name as the smart regenerative medicine (SRM). The SRM requires interdisciplinary efforts to finalize the pre-designed organs. Three-dimensional (3D) printing, as an additive manufacturing technology, has been widely used in various fields due to its high resolution and individuation. In SRM, with the assistance of 3D printing, cells and biomaterials could be precisely positioned to construct complicated tissues. This review summarizes the state of the SRM advances and focuses in particular on the 3D printing application in biofabrication. We further discuss the issues of SRM development and finally propose some approaches for future 3D printing, which involves SRM.
Collapse
Affiliation(s)
- Qi Gu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
- ARC Centre of Excellence for Electromaterials Science (ACES), Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong, NSW 2522, Australia
| | - He Zhu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Jing Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Xia Li
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Jie Hao
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Gordon G. Wallace
- ARC Centre of Excellence for Electromaterials Science (ACES), Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong, NSW 2522, Australia
| | - Qi Zhou
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| |
Collapse
|
28
|
Custom 3D-printed acetabular implants in hip surgery--innovative breakthrough or expensive bespoke upgrade? Hip Int 2016; 25:375-9. [PMID: 26351112 DOI: 10.5301/hipint.5000294] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 02/04/2023]
Abstract
Custom 3D-printed triflange acetabular cages are a new option in the armamentarium of the revision hip surgeon. This review article defines this technology, its indications, surgical method, advantages, disadvantages, use, current published literature and future applications.
Collapse
|
29
|
Stihsen C, Hipfl C, Kubista B, Funovics PT, Dominkus M, Giurea A, Windhager R. Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component. Bone Joint J 2016; 98-B:772-9. [DOI: 10.1302/0301-620x.98b6.36469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 02/08/2016] [Indexed: 11/05/2022]
Abstract
Aim Until now, there has been no consensus as to whether stemmed acetabular components are appropriate for use in patients undergoing revision total hip arthroplasty (THA) who have major acetabular defects or pelvic discontinuity. We wished to address this deficiency in the literature. Patients and Methods We carried out a retrospective study of 35 patients (six men and 29 women) with a mean age of 68 years (37 to 87), with major acetabular defects who underwent revision THA between 2000 and 2012. Results At a mean follow-up of 63 months (24 to 141), a total of 15 patients (43%) had required at least one further operation. Six implants (17%) loosened aseptically, four (11%) were further revised for infection and two (6%) for technical failure. By taking revision for any reason as the endpoint, the rate of survival of the implant was 61% after five years; by taking revision for aseptic loosening as the end point, it was 78%. The cumulative five-year survival for aseptic loosening was 94% in patients without pelvic discontinuity, and 56% in those with pelvic discontinuity. Conclusion These results indicate a significantly worse survival in patients with pelvic discontinuity (p = 0.020) and we advise caution in the use of the pedestal component in patients with major acetabular defects and pelvic discontinuity who require revision THA. As a result of these findings we have stopped using this implant and prefer to use particulate bone grafts protected with an anti-protrusion cage and posterior column plate fixation, if necessary. Take home message: Based on these poor results, we advise caution if using the pedestal component in patients with major acetabular defects with the presence of a pelvic discontinuity. Cite this article: Bone Joint J 2016;98-B:772–9.
Collapse
Affiliation(s)
- C. Stihsen
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - C. Hipfl
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - B. Kubista
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - P. T. Funovics
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - M. Dominkus
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - A. Giurea
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| | - R. Windhager
- Vienna General Hospital Medical University
of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria
| |
Collapse
|
30
|
The Use of Structural Distal Femoral Allograft for Acetabular Reconstruction of Paprosky Type IIIA Defects at a Mean 21 Years of Follow-Up. J Arthroplasty 2016; 31:680-3. [PMID: 26626773 DOI: 10.1016/j.arth.2015.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/30/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty in patients with a nonsupportive superior acetabulum often requires secondary augmentation beyond a hemispherical cup to achieve reliable fixation. Treatment options include using a higher hip center, jumbo cup, custom triflange implant, cages, or filling the superior defect with a bilobed implant, structural allograft, or metal augments. We previously reported a cohort of 31 patients treated with porous-coated hemispherical cups and distal femoral allograft for Paprosky type IIIA acetabular defects. METHODS The original cohort of 31 hips was retrospectively reviewed. Fourteen patients died with <15 years of follow-up, and 2 were lost to follow-up. This left 15 patients for evaluation including 5 males and 10 females, with an average age of 61 years (range: 37-74 years) at the time of surgery. Acetabular revision was performed with the use of a porous-coated hemispherical cup along with structural distal femoral allograft, cut to resemble the number 7, and secured with 6.5-mm cancellous screws with washers. RESULTS Overall, 7 hips failed, resulting in a Kaplan-Meier survivorship of 72% at 25 years of follow-up. In surviving patients, radiographs demonstrated components to be well fixed, and average Merle d'Aubigné score increased from 5 to 10 points. There were a subset of patients that failed early (median: 6.2 years), but the remaining patients demonstrated excellent clinical and radiographic results. CONCLUSIONS The use of distal femoral allograft can be considered in young patients with type IIIA acetabular defects that could benefit from restoration of bone stock.
Collapse
|
31
|
Mäkinen TJ, Fichman SG, Watts E, Kuzyk PRT, Safir OA, Gross AE. The role of cages in the management of severe acetabular bone defects at revision arthroplasty. Bone Joint J 2016; 98-B:73-7. [DOI: 10.1302/0301-620x.98b1.36307] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An uncemented hemispherical acetabular component is the mainstay of acetabular revision and gives excellent long-term results. Occasionally, the degree of acetabular bone loss means that a hemispherical component will be unstable when sited in the correct anatomical location or there is minimal bleeding host bone left for biological fixation. On these occasions an alternative method of reconstruction has to be used. A major column structural allograft has been shown to restore the deficient bone stock to some degree, but it needs to be off-loaded with a reconstruction cage to prevent collapse of the graft. The use of porous metal augments is a promising method of overcoming some of the problems associated with structural allograft. If the defect is large, the augment needs to be protected by a cage to allow ingrowth to occur. Cup-cage reconstruction is an effective method of treating chronic pelvic discontinuity and large contained or uncontained bone defects. This paper presents the indications, surgical techniques and outcomes of various methods which use acetabular reconstruction cages for revision total hip arthroplasty. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):73–7.
Collapse
Affiliation(s)
- T. J Mäkinen
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| | - S. G. Fichman
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| | - E. Watts
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| | - P. R. T. Kuzyk
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| | - O. A. Safir
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| | - A. E. Gross
- Mount Sinai Hospital, University of Toronto, 600
University Avenue, Toronto, Ontario M5G
1X5, Canada
| |
Collapse
|
32
|
Daivajna S, Duncan C, Masri B, Garbuz D. Highly porous metal shells and augments in revision hip surgery: Big hopes for big holes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.sart.2015.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
33
|
Trabecular Metal Augments for the Management of Paprosky Type III Defects Without Pelvic Discontinuity. J Arthroplasty 2015; 30:1024-9. [PMID: 25639856 DOI: 10.1016/j.arth.2015.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/22/2014] [Accepted: 01/02/2015] [Indexed: 02/01/2023] Open
Abstract
Fifty-five hips undergoing acetabular reconstruction with trabecular metal (TM)-coated cup and TM augments were reviewed at an average follow up of 53.7 months (36-91). Bony defects were Paprosky type IIIA in 42 and type IIIB without pelvic discontinuity in 13 hips. The average HHS increased from 40 (27-52) preoperatively to 90.5 (61-100) postoperatively (P<0.0001). Four (7.3%) of 55 hips underwent acetabular components revision: three cases of loosening (5.4%), and one of recurrent instability (1.8%) were reported. Survival rate at 2 and 5 years was 96.4% and 92.8%. In conclusion, the use of TM-coated cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity providing good clinical and radiographic outcomes in the mid term.
Collapse
|
34
|
von Roth P, Abdel MP, Wauer F, Winkler T, Wassilew G, Diederichs G, Perka C. Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J 2015; 96-B:1618-22. [PMID: 25452363 DOI: 10.1302/0301-620x.96b12.34256] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intact abductors of the hip play a crucial role in preventing limping and are known to be damaged through the direct lateral approach. The extent of trauma to the abductors after revision total hip replacement (THR) is unknown. The aim of this prospective study was to compare the pre- and post-operative status of the gluteus medius muscle after revision THR. We prospectively compared changes in the muscle and limping in 30 patients who were awaiting aseptic revision THR and 15 patients undergoing primary THR. The direct lateral approach as described by Hardinge was used for all patients. MRI scans of the gluteus medius and functional analyses were recorded pre-operatively and six months post-operatively. The overall mean fatty degeneration of the gluteus medius increased from 35.8% (1.1 to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision THRs (p = 0.03). There was a similar pattern after primary THR, but with considerably less muscle damage (p = 0.001), indicating progressive muscle damage. Despite an increased incidence of a positive Trendelenburg sign following revision surgery (p = 0.03) there was no relationship between the cumulative fatty degeneration in the gluteus medius and a positive Trendelenburg sign (p = 0.26). The changes associated with other surgical approaches to the hip warrant investigation.
Collapse
Affiliation(s)
- P von Roth
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - M P Abdel
- Mayo Clinic, Department of Orthopedic Surgery, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - F Wauer
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - T Winkler
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - G Wassilew
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - G Diederichs
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - C Perka
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
35
|
Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review. Hip Int 2014; 24:109-22. [PMID: 24186672 DOI: 10.5301/hipint.5000101] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 02/04/2023]
Abstract
Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal (TM) systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection.
Collapse
|
36
|
Results using Trabecular Metal™ augments in combination with acetabular impaction bone grafting in deficient acetabula. Hip Int 2014; 23:522-8. [PMID: 23813160 DOI: 10.5301/hipint.5000053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2013] [Indexed: 02/04/2023]
Abstract
We examined whether the use of trabecular metal wedges to fill segmental defects is an effective method of socket reconstruction when used in combination with impaction grafting and implantation of a cemented socket. Fifteen hips in 14 patients underwent impaction grafting in combination with a TM wedge with a minimum of two years follow-up. All patients had their defects assessed using the Paprosky classification. Patients were reviewed with x-rays and migration of the implant was measured. Outcome scores were also collected. Mean follow-up was 39 months (25-83). The mean age at surgery was 67.8 (49-85) years. Seven of the patients had previously undergone impaction grafting with the use of a stainless steel rim mesh to constrain the graft. None of the patients had failed either clinically or radiologically.
Collapse
|
37
|
Callado VM, de Sandes Kimura O, de Carvalho Leal D, Teixeira de Sousa Filho PG, Cury Fernandes MB, Carvalho de Almendra Freitas EH. Evaluation of the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. Rev Bras Ortop 2014; 49:364-9. [PMID: 26229828 PMCID: PMC4511618 DOI: 10.1016/j.rboe.2014.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE this study aimed to evaluate the fixation of the trabecular metal wedge in patients undergoing revision of total hip arthroplasty. METHODS twenty-three cases with minimum grading of Paprosky II-B that were operated between July 2008 and February 2013 were evaluated. These cases were evaluated based on radiographs before the operation, immediately after the operation and later on after the operation. Loss of fixation was defined as a change in the abduction angle of the component greater than 10° or any mobilization greater than 6 mm. RESULTS it was found that there was 100% fixation of the acetabula after a mean of 29.5 months. One case underwent removal of the implanted components due to infection. CONCLUSIONS there is still no consensus regarding the best option for reconstructing hips with bone loss. However, revision using a trabecular metal wedge has presented excellent short- and medium-term results. This qualifies it as an important tool for achieving a fixed and stable acetabular component.
Collapse
|
38
|
Avaliação da fixação da cunha de metal trabeculado em pacientes submetidos à revisão de artroplastia total de quadril. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2014.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
39
|
Beckmann NA, Weiss S, Klotz MCM, Gondan M, Jaeger S, Bitsch RG. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 2014; 29:229-35. [PMID: 23719095 DOI: 10.1016/j.arth.2013.04.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/01/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023] Open
Abstract
The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years) to determine if a difference with regard to revision failure could be determined. Failure rates of the respective implants were compared statistically using a logistic regression model with adjustment for discrepancies in FU time. In our study, TM shows statistically significant decreased loosening rates relative to revision rings for all grades including severe acetabular defects and pelvic discontinuity. The severe defects appear to benefit the most from TM.
Collapse
Affiliation(s)
- Nicholas A Beckmann
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
40
|
Abstract
The conventional method for reconstructing acetabular bone loss at revision surgery includes using structural bone allograft. The disadvantages of this technique promoted the advent of metallic but biocompatible porous implants to fill bone defects enhancing initial and long-term stability of the acetabular component. This paper presents the indications, surgical technique and the outcome of using porous metal acetabular augments for reconstructing acetabular defects. Cite this article: Bone Joint J 2013;95-B, Supple A:103–8.
Collapse
Affiliation(s)
- M. Abolghasemian
- Iran University of Medical Sciences, Shafa
hospital, Jaleh Street, Baharestan
Square, Tehran, 1157637131, Iran
| | - S. Tangsataporn
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - A. Sternheim
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - D. J. Backstein
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - O. A. Safir
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| | - A. E. Gross
- Division of Orthopaedics, Mount Sinai
Hospital, University of Toronto, 600 University
Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada
| |
Collapse
|
41
|
Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Systematic review on outcomes of acetabular revisions with highly-porous metals. INTERNATIONAL ORTHOPAEDICS 2013; 38:689-702. [PMID: 24178061 DOI: 10.1007/s00264-013-2145-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. METHOD A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. RESULTS The mean aseptic survivorship was 97.2% (range, 80-100%). The Harris hip scores improved from a mean pre-operative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of peri-acetabular radiolucencies was 2.4% (range, 0-8.8%) and 4.6% (range, 0-19%), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. CONCLUSION The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.
Collapse
Affiliation(s)
- Samik Banerjee
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
42
|
Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up. INTERNATIONAL ORTHOPAEDICS 2013; 37:605-10. [PMID: 23423427 DOI: 10.1007/s00264-013-1818-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/28/2013] [Indexed: 12/26/2022]
Abstract
PURPOSE Modular acetabular reconstructive cups have been introduced in an attempt to offer initial rigid fixation by iliac lag screws and ischial pegs, to support bone grafts with a flanged metal socket, and to restore original hip center in acetabular revision. The purpose of this study was to clarify minimum ten year follow-up results of this cup system with morsellised allografts in revision cases. METHODS We retrospectively investigated 54 acetabular revisions at a mean of 11 years (range, ten to 14 years). The indications were Paprosky's type 2B (eight hip), 2C (eight hips), 3A (23 hips), 3B (nine hips), and 4 (six hips). RESULTS Using aseptic loosening as the endpoints, the survival rate was 89.3 % (95 % CI 81-98). Radiographically, one type 3A hip, three type 3B hips and one type 4 hip showed aseptic loosening while no type 2 hips or no cemented cups showed loosening. CONCLUSIONS The modular reconstructive cups for acetabular revision showed bone stock restoration and stable implantation.
Collapse
|
43
|
Abstract
BACKGROUND Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants. QUESTIONS/PURPOSES We reviewed our early experience with THA using ultraporous acetabular components to assess the incidence and etiology of early failure and examine if any preoperative variables, including smoking, related to failure. METHODS We used ultraporous acetabular components in 498 patients (534 hips), beginning with one case each in 1999 and 2004, 17 in 2005, and the majority from 2006 through March 2010. There were 159 complex primary and 375 revision cases. Of these patients, 17% were smokers (averaging 35 pack-years), 31% previous smokers (averaging 29 pack-years), 41% nonsmokers, and 1% unknown. Failure modes possibly related to smoking were infection, aseptic loosening, or periacetabular fracture and unrelated were dislocation and implant breakage. Minimum followup was 1 month (average, 32 months; range, 1-78 months). RESULTS There were 34 cup failures (6%): 17 infections, 14 aseptic loosening, and one each liner breakage, dislocation, and periacetabular fracture. The failure rate (uncontrolled for potentially confounding variables) was 10% in both current (9 of 89) and prior smokers (17 of 167) and 3% in nonsmokers 8 of 271). CONCLUSION With ultraporous metal technology in complex primary and revision THA, smoking, both past and current, may be a risk factor for early failure. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
44
|
Schwartsmann CR, Boschin LC, Gonçalves RZ, Yépez AK, de Freitas Spinelli L. NEW BEARING SURFACES IN TOTAL HIP REPLACEMENT. Rev Bras Ortop 2012; 47:154-9. [PMID: 27042614 PMCID: PMC4799379 DOI: 10.1016/s2255-4971(15)30079-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 09/15/2011] [Indexed: 11/26/2022] Open
Abstract
Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty.
Collapse
Affiliation(s)
- Carlos Roberto Schwartsmann
- Full Professor of Orthopedics, Federal University of Health Sciences of Porto Alegre (UFCSPA), and Head of the Orthopedics and Traumatology Service, Hospital Complex of Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Anthony Kerbes Yépez
- Hip Surgery Group, Hospital Complex of Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | |
Collapse
|
45
|
Del Gaizo DJ, Kancherla V, Sporer SM, Paprosky WG. Tantalum augments for Paprosky IIIA defects remain stable at midterm followup. Clin Orthop Relat Res 2012; 470:395-401. [PMID: 22090355 PMCID: PMC3254742 DOI: 10.1007/s11999-011-2170-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Initial reports with short-term followup of porous tantalum acetabular components and augments for Paprosky IIIA acetabular defects demonstrate high hip scores, low rates of aseptic loosening, and low rates of complications. However, longer-term followup with a larger cohort is needed to determine the durability of these reconstructions. QUESTIONS/PURPOSES We therefore determined the functional scores, rates of aseptic loosening, and complications in patients with Paprosky IIIA acetabular defects treated with porous tantalum acetabular components and augments. METHODS We retrospectively reviewed 37 acetabular revisions in 36 patients (one patient with bilateral revisions) treated with a porous tantalum acetabular component and augment. All patients had defects classified as Type IIIa using the system of Paprosky et al. Harris hip scores were obtained and radiographic examination was performed before surgery and through most recent followup. The minimum followup was 26 months (mean, 60 months; range, 26-106 months). RESULTS One patient developed aseptic loosening of the acetabular reconstruction requiring revision; seven other patients required further surgery for periprosthetic femoral fracture (two), acute infection (three), and recurrent dislocation (two). Thirty-five of 37 hips had no or occasional pain at final followup. Mean Harris hip scores improved from 33.0 preoperatively (range, 12.6-58.7) to 81.5 postoperatively (range, 27.0-99.8). CONCLUSIONS Although the complication rate requiring further surgery was considerable, most patients with these reconstructions had pain relief and reasonable function with low rates of loosening at midterm followup. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Daniel J. Del Gaizo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Vamsi Kancherla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Scott M. Sporer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| | - Wayne G. Paprosky
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
- Central Dupage Hospital, 25 N Winfield Road, Winfield, IL 60190 USA
| |
Collapse
|
46
|
Abstract
Altered biomechanics secondary to hip ankylosis often result in degeneration of the lumbar spine, ipsilateral knee, and contralateral hip and knee. Symptoms in these joints may be reduced with conversion total hip arthroplasty (THA) of the ankylosed hip. THA in the ankylosed hip is a technically challenging procedure, and the overall clinical outcome is generally less satisfactory than routine THA performed for osteoarthritis and other etiologies. Functional integrity of the hip abductor muscles is the most important predictor of walking ability following conversion THA. Many patients experience persistent limp, and it can take up to 2 years to fully assess final functional outcome. Risk factors cited for increased risk of failed THA include prior surgical ankylosis and age <50 years at the time of conversion THA.
Collapse
|
47
|
Paxton ES, Keeney JA, Maloney WJ, Clohisy JC. Large acetabular defects can be managed with cementless revision components. Clin Orthop Relat Res 2011; 469:483-93. [PMID: 20922585 PMCID: PMC3018225 DOI: 10.1007/s11999-010-1563-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Optimal techniques for acetabular revision in the setting of major pelvic osteolysis have not been established. Bilobed components, structural grafts, and reinforcement cages have demonstrated 10-24% midterm failure rates. While cementless hemispherical components have been utilized to treat large acetabular defects, most reports have not focused specifically on patients with extensive deficiencies. QUESTIONS/PURPOSES We report midterm clinical scores, component revisions, and complications following focal bone grafting and cementless acetabular revision in cases with major periacetabular osteolysis. METHODS We identified 30 patients (32 hips) who underwent cementless acetabular revision to treat massive acetabular bone loss at an average followup of 53 months. We excluded three patients lost to followup and two patients who died prior to minimum 24 month followup. Harris Hip Scores were assessed before and after surgery. Postoperative radiographs were evaluated for graft incorporation and component migration. Component revision and component migration are reported as failures. RESULTS Mean Harris Hip Score improved from 52.5 (range, 17.7-90.7) to 87.3 (range, 25.3-100) points. Three hips (9%) were revised for aseptic loosening. Three components (10.7%) demonstrated radiographic migration, but were not revised. Complete graft incorporation was seen in 17 cases (68%). There were five major complications (14%). CONCLUSIONS Cementless acetabular fixation and bone grafting result in clinical scores and survivorship comparable to other options at midterm followup, with potential for biological fixation. LEVEL OF EVIDENCE Level IV, clinical research study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- E. Scott Paxton
- Department of Orthopaedics, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110 USA
| | - James A. Keeney
- Department of Orthopaedics, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110 USA
| | - William J. Maloney
- Department of Orthopaedics, Stanford University School of Medicine, Stanford, CA USA
| | - John C. Clohisy
- Department of Orthopaedics, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110 USA
| |
Collapse
|
48
|
Sakai T, Ohzono K, Nishii T, Miki H, Takao M, Sugano N. Grafting with hydroxyapatite granules for defects of acetabular bone at revision total hip replacement. ACTA ACUST UNITED AC 2010; 92:1215-21. [DOI: 10.1302/0301-620x.92b9.24555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The long-term results of grafting with hydroxyapatite granules for acetabular deficiency in revision total hip replacement are not well known. We have evaluated the results of revision using a modular cup with hydroxyapatite grafting for Paprosky type 2 and 3 acetabular defects at a minimum of ten years’ follow-up. We retrospectively reviewed 49 acetabular revisions at a mean of 135 months (120 to 178). There was one type 2B, ten 2C, 28 3A and ten 3B hips. With loosening as the endpoint, the survival rate was 74.2% (95% confidence interval 58.3 to 90.1). Radiologically, four of the type 3A hips (14%) and six of the type 3B hips (60%) showed aseptic loosening with collapse of the hydroxyapatite layer, whereas no loosening occurred in type 2 hips. There was consolidation of the hydroxyapatite layer in 33 hips (66%). Loosening was detected in nine of 29 hips (31%) without cement and in one of 20 hips (5%) with cement (p = 0.03, Fisher’s exact probability test). The linear wear and annual wear rate did not correlate with loosening. These results suggest that the long-term results of hydroxyapatite grafting with cement for type 2 and 3A hips are encouraging.
Collapse
Affiliation(s)
- T. Sakai
- Department of Orthopaedic Surgery
| | - K. Ohzono
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69, Inabasou, 565-8511 Amagasaki, Japan
| | - T. Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate, School of Medicine, 2-2, Yamadaoka, 565-0871, Suita, Japan
| | - H. Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, 540-0006, Osaka, Japan
| | - M. Takao
- Department of Orthopaedic Surgery
| | - N. Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate, School of Medicine, 2-2, Yamadaoka, 565-0871, Suita, Japan
| |
Collapse
|