Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2017; 8(7): 553-560
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.553
Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up
Francesco Roberto Evola, Luciano Costarella, Giuseppe Evola, Martina Barchitta, Antonella Agodi, Giuseppe Sessa
Francesco Roberto Evola, Luciano Costarella, Giuseppe Evola, Giuseppe Sessa, Department of Surgery, Orthopaedic Clinic, University of Catania, 95100 Catania, Italy
Martina Barchitta, Antonella Agodi, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95100 Catania, Italy
Author contributions: All authors contributed to drafting the work and approved it for publication; in particular, Evola FR and Sessa G designed and performed the research; Costarella L and Evola G dealt with the literature research; Barchitta M and Agodi A analyzed the data; Evola FR wrote the paper; Sessa G revised the manuscript.
Institutional review board statement: The Research Ethics Board has not considered it necessary to formulate authorization for this retrospective study because the data was analyzed anonymously and the results were reported in an aggregate manner.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest or financial relationships in the realization of this work.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesco Roberto Evola, MD, PhD, Department of Surgery, Orthopaedic Clinic, University of Catania, Via Plebiscito 628, 95100 Catania, Italy. robertoevola@virgilio.it
Telephone: +39-334-3370752
Received: January 28, 2017
Peer-review started: February 12, 2017
First decision: April 18, 2017
Revised: May 15, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: July 18, 2017
Processing time: 165 Days and 19 Hours
Abstract
AIM

To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.

METHODS

Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student’s t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method.

RESULTS

The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student’s t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student’s t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component.

CONCLUSION

The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.

Keywords: Porous tantalum; Bone defect; Acetabular revision; Osseointegration; Biological fixation; Augment; Retrospective study

Core tip: Revisions of acetabular implant components are frequently associated with bone defects. Porous tantalum acetabular cups and augments were introduced to improve biological fixing and restore the normal centre of rotation. The greatest advantage is for major bone defects, where the tantalum cup and augments provide stable primary fixing with the biological potential for bone ingrowth. Nowadays, porous tantalum represents the ideal bone substitute in prosthetic revisions.