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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Broekhuis D, Meurs WMH, Kaptein BL, Karunaratne S, Carey Smith RL, Sommerville S, Boyle R, Nelissen RGHH. High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery. Bone Jt Open 2024; 5:260-268. [PMID: 38555947 PMCID: PMC10981996 DOI: 10.1302/2633-1462.54.bjo-2023-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Aims Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.
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Affiliation(s)
- Demien Broekhuis
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemijne M. H. Meurs
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart L. Kaptein
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Scott Sommerville
- Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard Boyle
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rob G. H. H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands
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Selmene MA, Moreau PE, Zaraa M, Upex P, Jouffroy P, Riouallon G. Update on post-traumatic periprosthetic acetabular fractures. Bone Jt Open 2024; 5:28-36. [PMID: 38235509 PMCID: PMC10794891 DOI: 10.1302/2633-1462.51.bjo-2023-0083.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Aims Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Methods Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected. Results Our series included 20 patients, with a mean age of 77 years (46 to 90). All the patients had at least one comorbid condition. Radiographs showed that 75% of the fractures were pure transverse fractures, and a transverse component was present in 90% of patients. All our patients underwent surgical treatment: open reduction and internal fixation, revision of the acetabular component, or both. Mean follow-up was 24 months, and HHS at last follow-up was 75.5 (42 to 95). The principal complications observed were dislocations of the prosthesis (30%) and infections (20%). A need for revision surgery was noted in 30% of patients. No dislocation occurred in patients undergoing osteosynthesis with acetabular reconstruction. We did not note either mechanical loosening of the acetabular component nor thromboembolic complications. In all, 30% of patients presented acute anemia requiring transfusion, and one death was reported. Conclusion Post-traumatic periprosthetic acetabular fractures frequently have a transverse component that can destabilize the acetabular implant. The frequency of complications, principally dislocations, led to a high rate of revision surgery. Improvements in preoperative planning should make it possible to codify management to reduce this high rate of complications. The best results were obtained when the surgical strategy combined osteosynthesis with acetabular reconstruction.
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Affiliation(s)
- Mohamed A. Selmene
- Orthopaedic Department, Paris Saint-Joseph Hospital Group, Paris, France
- Faculty of medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Pierre E. Moreau
- Orthopaedic Department, Paris Saint-Joseph Hospital Group, Paris, France
| | - Mourad Zaraa
- Orthopaedic Department, Paris Saint-Joseph Hospital Group, Paris, France
| | - Peter Upex
- Orthopaedic Department, Paris Saint-Joseph Hospital Group, Paris, France
| | - Pomme Jouffroy
- Orthopaedic Department, Paris Saint-Joseph Hospital Group, Paris, France
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Shimamura M, Katayama N, Ohura H. Mean 14-year Outcomes of Hybrid Total Hip Arthroplasty Using Bulk Femoral Head Autografts for Acetabular Reconstruction. J Arthroplasty 2023; 38:2667-2672. [PMID: 37321520 DOI: 10.1016/j.arth.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND We aimed to evaluate the mean 14-year outcomes of hybrid total hip arthroplasty (THA) with cementless acetabular cups using bulk femoral head autografts in acetabular reconstruction and specify the radiological characteristics of cementless acetabular cups using this technique. METHODS This retrospective study included 98 patients (123 hips) who underwent hybrid THA with a cementless acetabular cup using bulk femoral head autografts for bone deficiency in acetabular dysplasia and who were followed-up for a mean of 14 years (range, 10 to 19.6). The percentage of bone coverage index (BCI) and cup center-edge (CE) angles were evaluation radiologically of acetabular host bone coverage. The survival rate of the cementless acetabular cup and autograft bone ingrowth were assessed. RESULTS The survival rate with all revisions of cementless acetabular cups was 97.1% (95% confidence interval: 91.2 to 99.1). The autograft bone was remodeled or reoriented in all cases except in 2 hips where the bulk femoral head autograft collapsed. Radiological evaluation revealed a mean cup CE angle of -17.8° (range, -52 to -7°) and a BCI of 44.4% (range, 10 to 75.4%). CONCLUSION Cementless acetabular cups using bulk femoral head autografts for bone deficiency of the acetabular roof remained stable even if the average BCI was 44.4% and the average cup CE angle was -17.8°. Cementless acetabular cups using these techniques showed good 10-year to 19.6-year outcomes and viabilities of graft bones.
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Affiliation(s)
- Masashi Shimamura
- Department of Orthopaedic Surgery, Shikoku Medical Center for Children and Adults, Zentsuji-shi, Kagawa, Japan; Hokkaido Orthopaedic Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Naoyuki Katayama
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Hisanori Ohura
- Hokkaido Orthopaedic Memorial Hospital, Sapporo, Hokkaido, Japan
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Liu Y, Wang F, Ying J, Xu M, Wei Y, Li J, Xie H, Zhao D, Cheng L. Biomechanical analysis and clinical observation of 3D-printed acetabular prosthesis for the acetabular reconstruction of total hip arthroplasty in Crowe III hip dysplasia. Front Bioeng Biotechnol 2023; 11:1219745. [PMID: 37790252 PMCID: PMC10543228 DOI: 10.3389/fbioe.2023.1219745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Objective: This study aimed to evaluate the biomechanical effectiveness of 3D-printed integrated acetabular prosthesis (IAP) and modular acetabular prosthesis (MAP) in reconstructing the acetabulum for patients with Crowe III developmental dysplasia of the hip (DDH). The results of this study can provide a theoretical foundation for the treatment of Crowe III DDH in total hip arthroplasty (THA). Methods: Finite element (FE) analysis models were created to reconstruct Crowe III DDH acetabular defects using IAP and MAP. The contact stress and relative micromotion between the acetabular prosthesis and the host bone were analyzed by gradually loading in three increments (210 N, 2100 N, and 4200 N). In addition, five patients with Crowe III DDH who underwent IAP acetabular reconstruction were observed. Results: At the same load, the peak values of IAP contact stress and relative micromotion were lower than those of MAP acetabular reconstruction. Under jogging load, the MAP metal augment's peak stress exceeded porous tantalum yield strength, and the risk of prosthesis fracture was higher. The peak stress in the bone interface in contact with the MAP during walking and jogging was higher than that in the cancellous bone, while that of IAP was higher than that of the cancellous bone only under jogging load, so the risk of MAP cancellous bone failure was greater. Under jogging load, the relative micromotion of the MAP reconstruction acetabular implant was 45.2 μm, which was not conducive to bone growth, while under three different loads, the relative micromotion of the IAP acetabular implant was 1.5-11.2 μm, all <40 μm, which was beneficial to bone growth. Five patients with IAP acetabular reconstruction were followed up for 11.8 ± 3.4 months, and the Harris score of the last follow-up was 85.4 ± 5.5. The imaging results showed good stability of all prostheses with no adverse conditions observed. Conclusion: Compared with acetabular reconstruction with MAP, IAP has a lower risk of loosening and fracture, as well as a better long-term stability. The application of IAP is an ideal acetabular reconstruction method for Crowe III DDH.
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Affiliation(s)
- Yuchen Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Fuyang Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jiawei Ying
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Minghao Xu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yuan Wei
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Junlei Li
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Hui Xie
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Liangliang Cheng
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Cursaru A, Iordache S, Costache M, Serban B, Popa M, Cretu B, Cirstoiu C. Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation. Cureus 2023; 15:e45432. [PMID: 37859882 PMCID: PMC10582587 DOI: 10.7759/cureus.45432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.
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Affiliation(s)
- Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Trauma, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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Liu Y, Wang F, Ying J, Cheng L, Zhao D. [Biomechanical research progress of common acetabular reconstruction techniques for Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:353-359. [PMID: 36940996 PMCID: PMC10027517 DOI: 10.7507/1002-1892.202211052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objective To summarize the characteristics and biomechanical research progress of common acetabular reconstruction techniques in patients with Crowe type Ⅱ and Ⅲ developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA), and provide references for selecting appropriate acetabular reconstruction techniques for clinical treatment of Crowe type Ⅱ and Ⅲ DDH. Methods The domestic and foreign relevant literature on biomechanics of acetabular reconstruction with Crowe type Ⅱ and Ⅲ DDH was reviewed, and the research progress was summarized. Results At present, there are many acetabular reconstruction techniques in Crowe type Ⅱ and Ⅲ DDH patients undergoing THA, with their own characteristics due to structural and biomechanical differences. The acetabular roof reconstruction technique enables the acetabular cup prosthesis to obtain satisfactory initial stability, increases the acetabular bone reserve, and provides a bone mass basis for the possible secondary revision. The medial protrusio technique (MPT) reduces the stress in the weight-bearing area of the hip joint and the wear of the prosthesis, and increases the service life of the prosthesis. Small acetabulum cup technique enables shallow small acetabulum to match suitable acetabulum cup to obtain ideal cup coverage, but small acetabulum cup also increases the stress per unit area of acetabulum cup, which is not conducive to the long-term effectiveness. The rotation center up-shifting technique increases the initial stability of the cup. Conclusion Currently, there is no detailed standard guidance for the selection of acetabular reconstruction in THA with Crowe type Ⅱ and Ⅲ DDH, and the appropriate acetabular reconstruction technique should be selected according to the different types of DDH.
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Affiliation(s)
- Yuchen Liu
- Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China
| | - Fuyang Wang
- Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China
| | - Jiawei Ying
- Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China
| | - Liangliang Cheng
- Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China
| | - Dewei Zhao
- Department of Orthopedics, Zhongshan Hospital, Dalian University, Dalian Liaoning, 116001, P. R. China
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Chen X, Li S, Liu X, Wang Y, Ma R, Zhang Y, Qian W. Acetabular Diameter Assessment and Three-Dimensional Simulation for Acetabular Reconstruction in Dysplastic Hips. J Arthroplasty 2023:S0883-5403(23)00087-6. [PMID: 36764404 DOI: 10.1016/j.arth.2023.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between acetabular width, three-dimensional (3D) simulation, and surgical results in total hip arthroplasty patients who have developmental dysplasia of the hip (DDH). METHODS This retrospective study included 216 DDH cases. Inner and outer acetabular width (OAW) was measured at the plane passing through the center of acetabular fossa. 3D simulation and 2D standard templating were performed. The actual cup size and the use of augments during surgery were recorded. Association among the indices and their distribution in different types of DDH were analyzed. RESULTS A difference of 13 to 14 millimeters (mm) was found between the inner acetabular width and actual cup size used in type II, III, and IV cases, while the difference was 0.2 to 3.6 mm for OAW. The accuracy of 2D templating and 3D simulation in predicting cup size was comparable in Crowe type I (86.5 versus 76%, P = .075), type II (72.7 versus 51.5%, P = .127), and type III (93.3 versus 66.7%, P = .169). The 3D simulation was significantly more accurate in Crowe type IV (89.1% versus 60.9%, P = .001). Augments and bone grafts were significantly more commonly used in type II (25%) than in the other types (0 to 6.5%). CONCLUSION OAW more accurately predicted actual cup size than inner acetabular width. The supero-lateral acetabular bone defects in type II cases require additional attention. Compared with 2D templating, 3D simulation is more accurate in predicting actual cup size in dysplastic hips with severe deformity and may be recommended in these selected cases, especially for Crowe IV patients.
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Affiliation(s)
- Xi Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, China; Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China; Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China; Longwood Valley, Beijing, China
| | - Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ruichen Ma
- School of Medicine, Tsinghua University, Beijing, China
| | | | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Fujimoto Y, Nakamura S, Ijuin T, Iuchi T, Nakajo M, Taniguchi N. Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device and allogeneic structural bone graft. J Orthop Surg (Hong Kong) 2022; 30:10225536221119719. [PMID: 35976732 DOI: 10.1177/10225536221119719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE One of the major problems in revision total hip arthroplasty (THA) is severe acetabular bone loss. The aim of our study was to evaluate the clinical outcomes of revision THA using a Kerboull-type reinforcement device (KT plate) and allogeneic structural bone graft. METHODS This retrospective study evaluated 48 hips that underwent revision THA using a KT plate and allogeneic structural bone graft between 2008 and 2016, with a median follow-up of 6.2 years (range 3-12.6 years). Functional outcome was assessed using the Japanese Orthopaedic Association (JOA) hip score. Postoperative and follow-up radiographs were compared to assess migration and breakage of the implant. RESULTS The mean JOA hip score improved from 45.6 (±16.3) points before surgery to 72.1 (±11.9) points at the most recent follow-up examination (p < 0.001). Two hips (4.2%) underwent re-revision THA because of cup loosening due to breakage of the KT plate. A total of 13 hips (27.1%) were classified as radiological failures. Binomial logistic regression analysis showed that a Kawanabe classification of stage 4, which indicates massive bone defects in the weight-bearing area, was a risk factor for radiological failure (odds ratio: 4.57; 95% confidence interval: 1.01-26.35). CONCLUSIONS A KT plate with an allogeneic structural bone graft is a useful method of acetabular reconstruction in revision THA that restores bone stock and improves hip function. Our findings indicated that a Kawanabe classification of stage 4 was a risk factor for radiological failure of the implant.
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Affiliation(s)
- Yusuke Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan.,Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Shunsuke Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Toshiro Ijuin
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Tomohiro Iuchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Masahide Nakajo
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
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Abstract
Aims After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074.
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Affiliation(s)
- Ahmed El-Bakoury
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.,El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
| | - Waseem Khedr
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK.,El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
| | - Mark Williams
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Yousry Eid
- El-Hadara University Hospital, Alexandria University, Alexandria, Egypt
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11
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Aguirre-Rodríguez VH, Santa María-Gasca NE, Valero-González FS. [Conservation of autologous graft of femoral head in bone flap for treatment of acetabular defects]. Acta Ortop Mex 2021; 35:465-468. [PMID: 35451258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe a bone preservation technique commonly used in neurosurgery in an orthopedic procedure. MATERIAL AND METHODS We describe the case of a patient who undergoes primary hip arthroplasty with an initial unsatisfactory result, the need for a revision with acetabular reconstruction is considered before the wound closure. Keeping the patient's femoral head in soft tissues for second-time reconstruction. RESULTS After six months of follow-up, complete osseointegration of the femoral head graft was found, with a good clinical and radiological evolution of the patient. Bone conservation techniques in bone flaps have shown good results in the grafts osseointegration in other areas such as neurosurgery. CONCLUSIONS The conservation of bone flaps in subcutaneous tissue for later use as a graft is a viable treatment option also in orthopedic surgery.
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Affiliation(s)
| | | | - F S Valero-González
- Clínica de Hombro y Codo. Hospital Ángeles Pedregal. Ciudad de México. México
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12
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Hamrayev AJ, Buyukkuscu MO, Misir A, Gursu SS. The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm. J Orthop Surg (Hong Kong) 2021; 28:2309499020957109. [PMID: 32996378 DOI: 10.1177/2309499020957109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. METHODS Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18-76) years. The mean follow-up duration was 76 ± 25 (range 25-161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. RESULTS The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30-48°) with mean graft coverage of 34 ± 4.8% (range 24-46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. CONCLUSION In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.
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Affiliation(s)
- Arif Jan Hamrayev
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Ozbey Buyukkuscu
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, 147020Health Science University Gaziosmanpasa Education and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- Department of Orthopaedics and Traumatology, 147008Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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13
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Thorat B, Singh A, Arshad M, Salokhe S, Mavani R. "Acute Primary Total Hip Arthroplasty for Combined Posterior Acetabulum Fracture with Ipsilateral Associated Posteriorly Dislocated Femoral Head with Femoral Neck Fracture. Using of Femoral Head as an Autograft Would be an Advantage". J Orthop Case Rep 2021; 11:85-90. [PMID: 34327173 PMCID: PMC8310644 DOI: 10.13107/jocr.2021.v11.i04.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Traumatic posterior hip dislocation with comminuted fracture of the ipsilateral acetabulum and femoral neck is a rare fracture pattern. These injuries are associated with high energy trauma and pose challenges during management. Controversy exists between hip preservation and replacement surgeries in middle-age patients. Open reduction and internal fixation (ORIF) have a high risk of non-union, avascular necrosis, and post-traumatic osteoarthritis of hip requiring total hip arthroplasty hip replacement (THA) as a secondary procedure later. Case Report: A 56-year-old male presented with posterior hip dislocation and comminuted fracture of ipsilateral wall and column of the acetabulum, and femoral neck following a high energy trauma. He was managed by acetabular reconstruction using femoral head structural autograft combined with acute primary uncemented THA. At 2-year follow-up, the patient had good functional outcome with a satisfactory range of motion without any difficulty in weight-bearing and doing his daily activities. Conclusion: Although uncommon, acetabular reconstruction using femoral head structural autograft and acute primary uncemented THA is a viable alternative treatment option compared to ORIF in middle-age patients with fracture of ipsilateral neck and acetabulum. This facilitates post-operative rehabilitation and avoids further operations for possible developing AVN or secondary arthritis.
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Affiliation(s)
- Babaji Thorat
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Avtar Singh
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Mohammad Arshad
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Sharad Salokhe
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Ravi Mavani
- Department of Orthopaedic Surgery, Amandeep Hospital, Amritsar, Punjab, India
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14
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Duarte GMH, Pires RE, Machado CJ, Andrade MAP. Reconstruction of Acetabular Defects With Impaction Grafting in Primary Cemented Total Hip Arthroplasty Produces Favorable Results: Clinical and Radiographic Outcomes Over 6.4 Years on Average. J Arthroplasty 2021; 36:200-209. [PMID: 32782122 DOI: 10.1016/j.arth.2020.07.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cemented primary total hip arthroplasty (THA) associated with acetabular reconstruction (AR) involving impacted bone grafting has been employed successfully in the revision of cavitary defects but the results are reportedly less predictable for segmental defects. The objective of the study is to evaluate the clinical and radiographic results of patients who had presented cavitary, segmental, and combined acetabular defects and received THA/AR involving impacted morselized cancellous bone autografts followed by rigorous postoperative management. METHODS Clinical outcomes were assessed retrospectively of 154 patients who had been submitted to 169 THA/AR procedures performed by a single surgeon over a 15-year period. The Harris Hip Score system was applied to 103 patients, and the degree of acetabular migration was determined from radiograph images of 91 AR procedures, of which 40 were segmental/combined and 51 were cavitary reconstructions. RESULTS The frequency of aseptic acetabular loosening was 3% while that of thromboembolic events was 4.1%. According to Harris Hip Score, 87.4% of outcomes were classified as excellent/good after an average follow-up period of 6.4 years irrespective of the type of acetabular defect. Horizontal and/or vertical acetabular migrations and changes in angular tilt were observed in all ARs, although the minor movements detected did not undermine the structural stability of the reconstructions or the functional capacity of patients. CONCLUSION The described THA/AR technique can be used effectively in the reconstruction of segmental/combined and cavitary acetabular defects. The success of the technique as applied to segmental/combined defects was attributed in part to the rigorous rehabilitation protocol with temporary postoperative weight-bearing restriction.
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Affiliation(s)
- Guydo M H Duarte
- Serviço de Ortopedia e Traumatologia, Instituto de Previdência dos Servidores do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Robinson E Pires
- Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carla J Machado
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marco A P Andrade
- Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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15
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Malahias MA, Ma QL, Gu A, Ward SE, Alexiades MM, Sculco PK. Outcomes of Acetabular Reconstructions for the Management of Chronic Pelvic Discontinuity: A Systematic Review. J Arthroplasty 2020; 35:1145-1153.e2. [PMID: 31784362 DOI: 10.1016/j.arth.2019.10.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/11/2019] [Accepted: 10/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A number of articles have been published reporting on the clinical outcomes of various acetabular reconstructions for the management of chronic pelvic discontinuity (PD). However, no systematic review of the literature has been published to date comparing the outcome and complications of different approaches to reconstruction. METHODS The US National Library of Medicine (PubMed/MEDLINE) and EMBASE were queried for publications from January 1980 to January 2019 using keywords pertinent to total hip arthroplasty, PD, acetabular dissociation, clinical or functional outcomes, and revision total hip arthroplasty or postoperative complications. RESULTS Overall, 18 articles were included in this analysis (569 cases with chronic PD). The overall survival rate of the acetabular components used for the treatment of chronic PD was 84.7% (482 of 569 cases) at mid-term follow-up, whereas the most common reasons for revision were aseptic loosening (54 of 569 hips; 9.5%), dislocations (45 of 569 hips; 7.9%), periprosthetic joint infection (30 of 569 hips; 5.3%), and periprosthetic fractures (11 of 569 hips; 1.9%). Both pelvic distraction technique (combined with highly porous shells) and custom triflanges resulted in less than 5% failure rates (96.2% and 95.8%, respectively) at final follow-up. Also, highly effective in the treatment of PD were cup-cages and highly porous shells with and/or without augments with 92% survivorship free of revision for aseptic loosening for both reconstruction methods. Inferior outcomes were reported for conventional cementless shells combined with acetabular plates (72.7%) as well as ilioischial cages and reconstruction rings (66.7% and 60.6% survivorship, respectively). CONCLUSION The current literature contains moderate quality evidence in support of the use of custom triflange implants and pelvic distraction techniques for the treatment of chronic PD, with a less than 5% all-cause revision rate and low complication rates at mean mid-term follow-up. Cup-cages and highly porous shells with or without augments could also be considered for the treatment of PD because both resulted in greater than 90% survival rates. Finally, there is still no consensus regarding the impact of different types of acetabular reconstruction methods on optimizing the healing potential of PD, and further studies are required in this area to better understand the influence of PD healing on construct survivorship and functional outcomes with each reconstruction method.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Qian-Li Ma
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY; Department of Orthopedic Surgery, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael M Alexiades
- Department of Orthopaedics, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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16
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Abstract
PURPOSE The aim of this study was to report the clinical and radiological outcome of using the modern porous metal cup in patients undergoing acute total hip arthroplasty (THA) for selected subset of acetabular fractures. PATIENT AND METHODS Eighteen patients with acetabular fracture underwent acute THA with modern porous metal cup from a single manufacturer. Fifteen males and three females with a mean age of 46.4 years (range 21-57 years) were ambispectively followed up for a minimum period of 48 months. All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays. RESULTS No patient was lost to follow-up. The HHS was excellent in nine patients, good in six patients, fair in two patients, and poor in one patient. All the fractures were united and the cups were well integrated. There was no lucent line seen in any acetabular zones on the X-rays. One patient had infection, which resolved with debridement. There was one dislocation following fall, which was reduced by closed means and remained stable. One of the two patients with heterotopic ossification had restricted movement of hip but not restricting the activities of daily living. No failures of acetabular component were seen in the study. CONCLUSION The current study showed that the modern porous metal cup provides sufficient primary stability and appear suitable for primary THA in acute acetabular fractures at mid-term follow-up: (i) In selected fractures, acute THA can be extended to young adult patients as well. (ii) Modern porous metal cup may provide sufficient stability with or without additional fixation required.
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Affiliation(s)
| | - Deepak Gautam
- Deepak Gautam, Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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17
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Wegrzyn J, Malatray M, Al-Qahtani T, Pibarot V, Confavreux C, Freyer G. Total Hip Arthroplasty for Periacetabular Metastatic Disease. An Original Technique of Reconstruction According to the Harrington Classification. J Arthroplasty 2018; 33:2546-2555. [PMID: 29656965 DOI: 10.1016/j.arth.2018.02.096] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/17/2018] [Accepted: 02/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periacetabular metastatic disease requires complex acetabular reconstruction. The complication rate for these frail patients is high. Various cement-rebar reinforced techniques allowing cemented total hip arthroplasty (THA) have been described. The optimal procedure has not yet been identified. METHODS A continuous series of 131 THAs performed in 126 patients with periacetabular metastatic disease was prospectively included in this study. After bone metastasis curettage and cementation, an original technique of acetabular reconstruction was performed using a dual mobility cup cemented into an acetabular reinforcement device (ie, Kerboull cross-plate or Burch-Schneider antiprotrusio cage) according to the Harrington classification. Functional outcome for independent ambulation in the community, pain relief, and occurrence of dislocation or mechanical failure of the acetabular reconstruction were assessed. RESULTS At a mean follow-up of 33 ± 17 months, the improvement in the preoperative to postoperative functional outcome and pain relief was significant (P < .001). The dislocation rate was 2%. Two of the 3 cases of dislocation occurred in acetabular reconstructions associated with a proximal femoral arthroplasty. No mechanical failure or aseptic loosening of the acetabular reconstruction was observed. CONCLUSION This study emphasized that our original technique combining bone metastasis curettage and cementation, acetabular reinforcement device and cemented dual mobility cup was effective to restore a painless functional independence and ensure a durable acetabular reconstruction able to face to adjuvant radiation therapy and mechanical solicitations for long survivors. In addition, dual mobility cup limited the risk of dislocation in patients undergoing THA for periacetabular metastatic disease.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France; Centre Expert des Métastases Osseuses-CEMOS, Hospices Civils de Lyon, Lyon, France; Lyon Cancer Institute, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Turki Al-Qahtani
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Cyrille Confavreux
- INSERM UMR 1033, Université de Lyon, Lyon, France; Centre Expert des Métastases Osseuses-CEMOS, Hospices Civils de Lyon, Lyon, France; Lyon Cancer Institute, Hospices Civils de Lyon, Lyon, France; Department of Rheumatology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gilles Freyer
- Lyon Cancer Institute, Hospices Civils de Lyon, Lyon, France
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Oe K, Iida H, Tsuda K, Nakamura T, Okamoto N, Ueda Y. Bone Remodeling in Acetabular Reconstruction Using a Kerboull-Type Reinforcement Device and Structural Bone-Grafting in Total Hip Arthroplasty. J Arthroplasty 2017; 32:908-914. [PMID: 27687810 DOI: 10.1016/j.arth.2016.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/06/2016] [Accepted: 08/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify the long-term durability of the Kerboull-type reinforcement device (KT plate) in acetabular reconstruction for massive bone defects, assessing the remodeling of structural bone grafts. METHODS This study retrospectively evaluated 106 hips that underwent acetabular reconstruction using a KT plate between November 2000 and December 2010. Thirty-eight primary total hip arthoplasties (THAs) and 68 revised THAs were performed, and the mean duration of clinical follow-up was 8 years (5-14 years). Regarding reconstructing the acetabular bone defects, autografts were used in 37 hips, allografts in 68 hips, and A-W glass ceramics in 2 hips. RESULTS One hip exhibited radiological migration and no revision for aseptic loosening. The mean Merle d'Aubigné Clinical Score improved from 7.5 points (4-12 points) preoperatively to 10.9 points (9-18 points) at the last follow-up. The Kaplan-Meier survival rate for radiological migration of primary and revised THAs at 10 years was 100% and 97% (95% confidence interval: 96%-100%), respectively. Bone remodeling was evaluated using the radiological demarcation at the bone-to-bone interface, and an improvement of 100% in primary THAs and 94% in revised THAs was observed. CONCLUSION For massive bone defects, acetabular reconstruction using the KT plate with a structural bone grafting can yield successful results.
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Affiliation(s)
- Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hirokazu Iida
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kohei Tsuda
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomohisa Nakamura
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Naofumi Okamoto
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yusuke Ueda
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
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Gavaskar AS, Gopalan H, Karthik B, Srinivasan P, Tummala NC. Delayed Total Hip Arthroplasty for Failed Acetabular Fractures: The Influence of Initial Fracture Management on Outcome After Arthroplasty. J Arthroplasty 2017; 32:872-876. [PMID: 27776903 DOI: 10.1016/j.arth.2016.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) provides a successful salvage option for failed acetabular fractures. The complexity of arthroplasty for a failed acetabular fracture will depend on the fracture pattern and the initial management of the fracture. Our objective was to compare the midterm outcome of THA between patients who presented with failed acetabular fractures following initial surgical or nonsurgical treatment. METHODS Forty-seven patients underwent cementless THA ± acetabular reconstruction following failed treatment of acetabular fractures. Twenty-seven were initially treated by surgery (group A) and 20 had nonsurgical treatment (group B). Intraoperative measures, preoperative and follow-up clinical, radiological, and functional outcomes were compared between the 2 groups. RESULTS The mean surgical time, blood loss, and need for blood transfusion were significantly less in group A (P < .05). Acetabular reconstruction to address cavitary or segmental defects was needed in a significantly higher number of patients in group B (P = .006). Significant improvement in modified Merle d'Aubigne and Oxford scores was seen postsurgery in both groups. Acetabular component survival with aseptic loosening as end point was 98%. Overall survival rate with infection, revision, or loosening as end point was 93% at a mean follow-up of 7 years ± 17 months. CONCLUSION THA for a failed acetabular fracture is greatly facilitated by initial surgical treatment. Although functional results and survivorship were similar in both groups, failed nonsurgical treatment in complex fractures is associated with migrated femoral head and extensive acetabular defects requiring complex acetabular reconstruction.
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Affiliation(s)
| | - Hitesh Gopalan
- Department of Orthopedics, MOSC Medical College, Cochin, India
| | - Bhupesh Karthik
- Department of Orthopedics, Sri Ramachandra Medical College, Chennai, India
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Duncan JM, Nahas S, Akhtar K, Daurka J. The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery. J Orthop Case Rep 2016; 5:23-5. [PMID: 27299013 PMCID: PMC4719345 DOI: 10.13107/jocr.2250-0685.247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Surgical management of acetabular fractures is often highly complex, and a successful outcome depends upon an appreciation of the fracture pattern and the most appropriate approach to reduce and hold it. Currently, computed tomography (CT) images are used in conjunction with plain x-rays to identify the main fracture components and their spatial relationship to one another, and as such surgeons still have to make decisions based upon their ability to visualise the fracture from the images available. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. Case Report: This report describes the use of a 3D printer to create a life-size model reconstruction of the pelvis of a 48 year old male patient who sustained a left sided associated both column acetabular fracture following a motorbike accident in the Sahara Desert. The model allowed visualisation of the multiple fracture fragments and their relative displacements. The tactile feedback allowed assessment of the different fracture fragments. The relative displacement of the quadrilateral plate and posterior column fragments could be assessed and the surgeon felt that these would be amenable to reduction from an ilioinguinal approach. An anatomic reduction was achieved and was held with the application of a pelvic brim plate with 2 screws lagging the posterior column/quadrilateral plate fragment. Conclusion: There are previous examples of 3D models being used in orthopaedic surgery through the use of rapid prototyping, however this method is usually expensive and time consuming. Advances in 3D printer technology offer surgeons a number of advantages when treating these complex fractures. With the ever-increasing economy, ease of use and speed of additive processing, the possible applications of this technology within orthopaedic surgery are numerous. Given the possible applications of this technology, and its ever increasing availability, we feel that its use can only improve patient outcomes and so should be explored further for use in orthopaedic surgery.
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Nie Y, Pei F, Shen B, Kang P, Li Z. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction. Comput Methods Biomech Biomed Engin 2015; 19:977-84. [PMID: 26469561 DOI: 10.1080/10255842.2015.1085025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.
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Affiliation(s)
- Yong Nie
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Fuxing Pei
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Bin Shen
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Pengde Kang
- a Department of Orthopedics , West China Hospital, Sichuan University , Chengdu , China
| | - Zongming Li
- b Department of Biomedical Engineering , Cleveland Clinic Lerner Research Institute , Cleveland , OH , USA
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Kim Y, Tanaka C, Kanoe H. Long-Term Outcome of Acetabular Reconstruction Using a Kerboull-Type Acetabular Reinforcement Device with Hydroxyapetite Granule and Structural Autograft for AAOS type II and III Acetabular Defects. J Arthroplasty 2015; 30:1810-4. [PMID: 25981327 DOI: 10.1016/j.arth.2015.04.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/17/2015] [Accepted: 04/22/2015] [Indexed: 02/01/2023] Open
Abstract
We evaluated the clinical results of the reconstruction of acetabular bone deficiency using hydroxyapatite (HA) granules and structural autografts supported by a Kerboull-type acetabular reinforcement device at a minimum of 10 years follow-up. Between 1993 and 2003, 40 consecutive THA revisions were performed in 37 patients with a mean age of 66.4 years. The mean follow-up period was 12.8 years. Radiologically, 5 hips failed, of which 2 were revised. The survival rate of the acetabular component at 10 years was 100% in type II defects and 94.9% in the type III defects, using acetabular revision for loosening as the end point. Acetabular reconstruction with HA granules, structural autografts and a Kerboull-type acetabular reinforcement device provided satisfactory clinical and radiological results at 12.8 years postoperatively.
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Affiliation(s)
- Youngwoo Kim
- Department of Orthopaedics, Kyoto City Hospital, Nakagyo, Kyoto, Japan
| | - Chiaki Tanaka
- Department of Orthopaedics, Kyoto City Hospital, Nakagyo, Kyoto, Japan
| | - Hiroshi Kanoe
- Department of Orthopaedics, Kyoto City Hospital, Nakagyo, Kyoto, Japan
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Grappiolo G, Loppini M, Longo UG, Traverso F, Mazziotta G, Denaro V. 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] [What about the content of this article? (0)] [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.
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Nie Y, Pei F, Shen B, Kang P, Li Z. Implication of acetabular width on the anteroposterior pelvic radiograph of patients with developmental dysplasia of the hip. J Arthroplasty 2015; 30:489-94. [PMID: 25311162 DOI: 10.1016/j.arth.2014.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/03/2014] [Accepted: 09/23/2014] [Indexed: 02/01/2023] Open
Abstract
Radiographic parameters that can help acetabular reconstruction during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) are few. The radiographs of 138 dysplastic hips that had undergone cementless THA were evaluated regarding the acetabular width above the acetabular component and the coverage of the component by native bone. The acetabular reconstruction process was simulated using 3D models from CT data, and the acetabular component coverage was calculated in 3D space based on the measurement and algorithm we proposed. Significant positive correlation between the acetabular width and the acetabular component coverage was found. Our study introduced a useful parameter, which can mark the superior reference position of the acetabular component for acetabular reconstruction in DDH patients.
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Affiliation(s)
- Yong Nie
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Pengde Kang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zongming Li
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
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Li H, Wang L, Mao Y, Wang Y, Dai K, Zhu Z. Revision of complex acetabular defects using cages with the aid of rapid prototyping. J Arthroplasty 2013; 28:1770-5. [PMID: 23507065 DOI: 10.1016/j.arth.2012.12.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 11/29/2012] [Accepted: 12/13/2012] [Indexed: 02/01/2023] Open
Abstract
This study details a method using rapid prototyping (RP) technique to assist in acetabular revision with complex bone defects. Hemi-pelvic RP models were built among 25 patients with complex acetabular bone defects. Each patient was scheduled to undergo revision using either commercially available or customized cages based on individualized RP models. Average follow-up was 4.4 years (range, 1 to 9 years). The average Harris hip score was 36.1 (range, 20 to 58) preoperatively and reached an average of 82.6 (range, 60-96) at the last follow-up. No mechanical failure or loosening was observed. One patient experienced hip dislocation 4 days postoperatively. The resultant findings of this study merit consideration of RP as a helpful clinical complement for dealing with some complex bone defect of acetabulum.
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Affiliation(s)
- Huiwu Li
- Department of Orthopaedics, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
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