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Cipolla A, Vella-Baldacchino M, Le Baron M, Argenson JN, Flecher X. Using Porous Tantalum Uncemented Components to Manage Acetabular Defects and to Restore the Hip Center of Rotation in Revision Total Hip Arthroplasty: A Minimum Ten-Year Clinical and Radiological Study. J Arthroplasty 2025; 40:1284-1292. [PMID: 39481618 DOI: 10.1016/j.arth.2024.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 10/14/2024] [Accepted: 10/20/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Managing acetabular defects and restoring the hip center of rotation (COR) in revision hip arthroplasty is considered a complex and challenging surgery. Among many existing options, porous tantalum components have shown favorable short-term (less than ten years) follow-up results. The present study aimed to describe clinical and radiographic outcomes in longer-term follow-up. METHODS Between 2006 and 2013, 98 patients who underwent this surgical technique in our institute were clinically and radiographically reviewed. Rerevisions for aseptic loosening of the acetabular component were examined to consider the survivorship of the implant as the primary endpoint. The clinical outcome was measured using the Harris Hip Score. Radiological signs of osseointegration, radiolucency lines, acetabular stability, and position of the hip COR were evaluated at the immediate postoperative and last follow-up radiographs. RESULTS The cup survivorship was 96% at a mean follow-up of 14 years (range, 10 to 17). Global survivorship was 83.6% if any reason for rerevisions was considered an endpoint. The most frequent complications were dislocation (13.7%) and infections (12%). Overall, 13 patients died, and 17 patients were lost to follow-up. There were 73 patients available for clinical and radiographic evaluation. The mean Harris Hip Score was 81 (range, 39 to 100). More than 80% of hips showed radiological evidence of osseointegration, and no change was found in COR position at last follow-up radiographs. CONCLUSIONS The use of porous tantalum uncemented components to manage revision hip arthroplasty can be considered a favorable solution for managing acetabular defects and restoring the hip COR with satisfactory clinical and radiological results in a long-term follow-up.
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Affiliation(s)
- Alessandra Cipolla
- University of Turin, CTO Hospital (C.T.O. Centro Traumatologico Ortopedico), Torino, Italy; Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Martinique Vella-Baldacchino
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; MSk Lab - Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
| | - Marie Le Baron
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Service de Chirurgie Orthopédique, Hôpital Nord, Pôle Locomoteur, Institut du Mouvement et de L'appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Jean-Noel Argenson
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
| | - Xavier Flecher
- Aix-Marseille University, AP-HM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France; Service de Chirurgie Orthopédique, Hôpital Nord, Pôle Locomoteur, Institut du Mouvement et de L'appareil Locomoteur, Assistance Publique-Hôpitaux de Marseille, Marseille, France
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Ceddia M, Solarino G, Pulcrano A, Benedetto A, Trentadue B. Finite Element Analysis of a 3D-Printed Acetabular Prosthesis for an Acetabular Defect According to the Paprosky Classification. MATERIALS (BASEL, SWITZERLAND) 2025; 18:1295. [PMID: 40141579 PMCID: PMC11943772 DOI: 10.3390/ma18061295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 03/12/2025] [Accepted: 03/14/2025] [Indexed: 03/28/2025]
Abstract
The treatment of Paprosky Type III acetabular defects is a significant challenge in orthopedic surgery, as standard components often do not fit properly. This study aims to evaluate the biomechanical efficacy of a custom 3D-printed PEEK acetabular prosthesis compared to a conventional titanium implant. A 3D model of the pelvis was created using a computed tomography scanner and a custom-made acetabular implant was designed. Finite element analysis (FEA) was performed using Ansys Workbench to evaluate the stress and strain distribution of two materials on the pelvic bone. The results showed that the titanium prosthesis model had less strain transmitted to the bone, while the PEEK model had better stress transmission and bone stimulation. The use of custom implants reduced the risk of stress shielding, potentially improving long-term bone health. Three-dimensional-printed acetabular prostheses therefore offer significant advantages over traditional implants, suggesting improved implant stability and reduced failure rates.
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Affiliation(s)
- Mario Ceddia
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy;
| | - Giuseppe Solarino
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Alessandro Pulcrano
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Antonella Benedetto
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70125 Bari, Italy; (G.S.); (A.P.); (A.B.)
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy;
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Garner E, Meynen A, Scheys L, Wu J, Zadpoor AA. Automated design of bone-preserving, insertable, and shape-matching patient-specific acetabular components. J Orthop Res 2024; 42:2535-2544. [PMID: 39004739 DOI: 10.1002/jor.25927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024]
Abstract
Effective treatment of large acetabular defects remains among the most challenging aspects of revision total hip arthroplasty (THA), due to the deficiency of healthy bone stock and degradation of the support columns. Generic uncemented components, which are favored in primary THA, are often unsuitable in revision cases, where the bone-implant contact may be insufficient for fixation, without significant reaming of the limited residual bone. This study presents a computational design strategy for automatically generating patient-specific implants that simultaneously maximize the bone-implant contact area, and minimize bone reaming while ensuring insertability. These components can be manufactured using the same additive manufacturing methods as porous components and may reduce cost and operating-time, compared to existing patient-specific systems. This study compares the performance of implants generated via the proposed method to optimally fitted hemispherical implants, in terms of the achievable bone-implant contact surface, and the volume of reamed bone. Computer-simulated results based on the reconstruction of a set of 15 severe pelvic defects (Paprosky 2A-3B) suggest that the patient-specific components increase bone-implant contact by 63% (median: 63%; SD: 44%; 95% CI: 52.3%-74.0%; RMSD: 42%), and reduce the volume of reamed bone stock by 97% (median: 98%; SD: 4%; 95% CI: 95.9%-97.4%; RMSD: 3.7%).
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Affiliation(s)
- Eric Garner
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alexander Meynen
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Jun Wu
- Department of Sustainable Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Li W, Liu D, Liu X, Li X. Application of Intraoperative Individualized Cup Combination-Cup-on-Cup Technique in Severe Acetabular Defects. Orthop Surg 2024; 16:2853-2861. [PMID: 39311082 PMCID: PMC11541136 DOI: 10.1111/os.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 11/08/2024] Open
Abstract
This study aimed to investigate the application of the cup-on-cup technique in revision total hip arthroplasty (THA) and report clinical and radiographic outcomes from a series of case follow-ups. Retrospective analysis of 10 patients who underwent acetabular prosthesis revision with cup-on-cup technique. According to the Paprosky classification of acetabular bone defects, there were 2 cases of type II C, 3 cases of type III A, and 5 cases of type III B. The average follow-up was 54.8 ± 5.1 months, and the Harris score of the hip joint increased from 37.0 ± 9.9 preoperatively to 80.5 ± 3.1 postoperatively at the final follow-up (p < 0.001). Comparing the surgical side's hip center of rotation (COR) to the contralateral side, the preoperative average upward displacement was 33.8 ± 15.0 mm, while the postoperative average upward displacement was 0.2 ± 3.3 mm (p < 0.001). Similarly, the preoperative average inward displacement was 9.1 ± 5.1 mm, while the postoperative average outward displacement was 1.8 ± 1.6 mm (p < 0.001). There was no significant difference (p = 0.71) between the average density values of the contralateral and surgical sides at the final follow-up, which were 127.4 ± 13.7 and 125.0 ± 14.8, respectively. During the follow-up period, all patients achieved satisfactory radiographic outcomes, and no prosthetic loosening was observed. The cup-on-cup technique can reconstruct acetabular bone defects and restore hip COR in revision THA, with favorable clinical and radiographic outcomes.
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Affiliation(s)
- Weihua Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Daobi Liu
- JiuJiang No.171 HospitalJiujiangChina
| | - Xuqiang Liu
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Xiaofeng Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
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Chaudhry F, Daud A, Greenberg A, Braunstein D, Safir OA, Gross AE, Kuzyk PR. Cup-Cage Construct for Treatment of Severe Acetabular Bone Loss in Revision Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Mean Follow-Up of 7.7 Years. J Arthroplasty 2024; 39:2555-2560. [PMID: 39002767 DOI: 10.1016/j.arth.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Acetabular reconstruction in the context of massive acetabular bone loss is challenging. Achieving implant stability in these situations requires special considerations. The cup-cage construct is a treatment option that addresses this issue. This study evaluates survivorship, complications, and functional outcomes using the cup-cage construct. METHODS A total of 131 cup-cage implants (129 patients) were identified from our retrospective review of revision total hip arthroplasties from January 2003 to January 2022. Among these cases, 100 (76.3%) were women, the mean age at the time of surgery was 68 years (range, 29 to 92; SD [SD], 12.4), and the mean follow-up was 7.7 years (range, 0.02 to 20.3; SD, 5.1). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery and/or failure of the cup-cage reconstruction. RESULTS At a mean follow-up of 7.7 years, the cup-cage construct survivorship due to all-cause failure was 83.9% (95% CI [confidence interval]: 77.6 to 90.2) at 5 years with 88 hips at risk, 74.8% (95% CI: 66.2 to 83.4) at 10 years with 38 hips at risk, and 69.8% (95% CI: 59.4 to 80.2) at 15 years with 11 hips at risk. The survivorship due to failure from aseptic loosening was 96.7% (95% CI: 93.6 to 99.8) at 5 years with 88 hips at risk and 95.5% (95% CI: 91.6 to 99.4) at 10 and 15 years with 38 and 11 hips at risk, respectively. The revision rate for aseptic loosening of the cup and/or cage, infection, dislocation, and aseptic loosening of the femoral stem was 5 of 131 (3.8%), 12 of 131 (9.1%), 10 of 131 (7.6%), and 2 of 131 (1.5%). CONCLUSIONS The cup-cage construct is a reliable treatment option for the treatment of various acetabular defects. There are favorable survivorship, clinical, and radiographic outcomes, with a satisfactory complication rate.
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Affiliation(s)
- Faran Chaudhry
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anser Daud
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arieh Greenberg
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Doris Braunstein
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan E Gross
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paul R Kuzyk
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Salimy MS, Minutillo GT, Melnic CM, Paprosky WG, Sheth NP. Acetabular Distraction: Promising 5-Year Outcomes for the Treatment of Chronic Pelvic Discontinuity. J Arthroplasty 2024; 39:S188-S193. [PMID: 38729228 DOI: 10.1016/j.arth.2024.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Severe acetabular bone loss encountered during revision total hip arthroplasty (THA) poses a clinical challenge. In cases involving pelvic discontinuity, where the ilium is separated superiorly from the inferior ischiopubic segment through the acetabulum, acetabular distraction may be used to restore the biomechanics of the hemipelvis. This technique allows for correct sizing of the acetabulum, and the subsequent peripheral distraction and medial compression at the discontinuity provide initial mechanical stability and biological fixation as bone in growth occurs. Accordingly, this study aimed to assess long-term 5-year outcomes following acetabular distraction across 2 institutions. METHODS We retrospectively identified all patients who underwent revision THA in which the acetabular distraction technique was performed for the treatment of chronic pelvic discontinuity between 2002 and 2018. Demographic, operative, and clinical postoperative data were collected. Clinical endpoints included postoperative radiographic outcomes, complications requiring additional surgery, and reoperation for all causes. Only patients who had a minimum 5-year follow-up were included in this study. RESULTS A total of 15 patients (Paprosky IIC: one patient, 6.7%; Paprosky IIIA: 5 patients, 33.3%; Paprosky IIIB: 9 patients, 60%) who had a mean follow-up time of 9 years (range, 5.1 to 13.5) were analyzed. Porous tantalum augments were used in 11 (73.3%) cases to primarily address posteriorsuperior defects (100%). There were 4 (26.7%) patients that required reoperation, only 2 of which were for indications related to the acetabular construct, leading to an overall survivorship of 86.7%. Both patients had a prior revision THA before the implementation of the distraction technique. Evidence of bridging callus formation was reported radiographically for 14 (93.3%) patients at the time of the last clinical follow-up. CONCLUSIONS For patients who have chronic pelvic discontinuity, acetabular distraction shows promising long-term outcomes. Even so, larger multi-center studies are needed to better support the efficacy of this technique. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory T Minutillo
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Melnic CM, Salimy MS, Minutillo GT, Paprosky WG, Sheth NP. Acetabular Distraction Technique: A Multicenter Study With a Minimum 2-Year Radiographic Follow-Up. J Arthroplasty 2024; 39:S398-S403. [PMID: 38401613 DOI: 10.1016/j.arth.2024.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity. METHODS Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct. RESULTS Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up. CONCLUSIONS To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory T Minutillo
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Koch K, Nolte I, Hahn M, Becker A. 20-year Results of a 3D Titanium Mesh Coating Stability of 31 Artificial Cups. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:263-271. [PMID: 37044122 DOI: 10.1055/a-2003-6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND The aim of this work was to demonstrate the bony bond strength and resilience of a three-dimensional titanium mesh coating of an artificial acetabulum produced using the diffusion bonding technique. Under the extreme conditions ranging from abrasion-related osteolysis to acetabular perforation, the degree of residual bone and the integrity of the coating were determined. The remaining zones of the (still) stable bone connection are inevitably exposed to a greater load of the layer adhesion between the titanium mesh and the core shell. The investigation was intended to provide information about the stages of damage according to Paprosky in which it was still justifiable to leave the implant in place and simply change the inlay from the purely material-technical point of view of a stable coating. The bond between bone and implant was examined with regard to a possible retention of the implant for its adaptive remodeling up to 27 years. MATERIALS AND METHODS In a retrospective study, 31 explanted human acetabular cups of the Harris-Galante II type, with an average lifetime of 19.7 years (11-27 years), were examined by means of digital area measurement to determine both the bone areas remaining on the coating and the damaged areas of the titanium mesh. Periacetabular bone loss was recorded in a modified Paprosky (PAP) damage classification. Full hemispherical sections of 4 acetabular cups with a life time of 16, 20, 22 and 27 years were examined histopathologically using the diamond cut technique. RESULTS The periacetabular bone loss resulted in damage class PAP I in 8 cases, PAP IIa in 7 cases, PAP IIb in 2 cases, PAP IIc in 9 cases, PAP IIIa in 3 cases and PAP IIIa in 2 cases PAP IIIb. The average amount of bone that was still firmly attached to the coating after explantation was 17% (0-70%) of the total cup surface. Paprosky I accounted for 44.1%, and PAP IIa and IIb stadiums together a total of 17.1%. The average bone fraction of the implants no longer anchored in the host bed at stages IIc, IIIa and IIIb was 2%. The average coating damage was 11% (0-100%) and was exclusively attributable to the unstable implants of stages IIc, IIIa and IIIb. The histopathological findings showed adaptive bone remodeling, that was detectable for up to 27 years through the titanium mesh down to the interface with the solid acetabular core. The titanium wire mesh was mostly surrounded by lamellar, mature bone. CONCLUSION The results show that the connection between the Tivanium cup and the previously oldest and unchanged sintered coating - in the form of a three-dimensional titanium mesh applied in point and line contact - is very load-resistant even under the extreme loads of periacetabular osteolysis and cup perforations. Since there was no damage to the coating in periacetabular damage stages Paprosky I, IIa and IIb, it is justifiable in these damage stages to leave the implant in situ and to continue to use it with sole replacement of the inlay, but leaving the socket shell. The third-generation acetabular cup (Trilogy) with unchanged three-dimensional titanium mesh coating has been implanted in over 1.2 million cases for 26 years. After a long service life, an increasing number of wear and tear conditions can be expected in today's mostly elderly and vulnerable patient clientele. In view of the results presented here, the early detection of damage would make it possible to avoid costly and stressful explantation of the entire acetabular cup in favor of replacing the sole inlay in Paprosky stages I, IIa and IIb.
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Affiliation(s)
- Katharina Koch
- Klinik für Kleintiere, Tierärztliche Hochschule Hannover, Hannover, Deutschland
| | - Ingo Nolte
- Klinik für Kleintiere, Tierärztliche Hochschule Hannover, Hannover, Deutschland
| | - Michael Hahn
- Institut für Osteologie und Biomechanik IOBM, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Andreas Becker
- Orthopädie und Unfallchirurgie, GFO- Kliniken Troisdorf, Troisdorf, Deutschland
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Chung BC, Heckmann ND, Gallo MC, Steck T, Jimenez C, Oakes DA. Trabecular Metal Augments During Complex Primary Total Hip Arthroplasty. Arthroplast Today 2024; 27:101435. [PMID: 38946923 PMCID: PMC11214375 DOI: 10.1016/j.artd.2024.101435] [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: 07/19/2023] [Revised: 03/25/2024] [Accepted: 05/01/2024] [Indexed: 07/02/2024] Open
Abstract
Background Trabecular metal augments (TMAs) have been extensively used in revision total hip arthroplasty (THA) to address acetabular bone defects. However, limited data exists regarding TMA utilization during primary THA. This study aims to assess the clinical and radiographic outcomes of TMAs used during primary THA. Methods A single-institution retrospective case series of primary THA patients treated with TMA between 2010 and 2019 was performed. Patient demographics, complications, and revisions were recorded. Cup position, center of rotation, leg length, and radiolucent lines were assessed radiographically. The Kaplan-Meier method was used to compute implant survivorship. Results Twenty-six patients (30 hips) were included with average age of 52.6 ± 15.3 years (range: 22-78) and mean follow-up of 4.1 ± 2.1 years (range: 2.0-8.9). Most TMAs were indicated for developmental dysplasia of the hip (n = 18; 60.0%). On average, hip center of rotation was lowered 1.5 ± 1.3 cm and lateralized 1.2 ± 1.5 cm, while leg length and global offset were increased by 2.4 ± 1.2 cm and 0.4 ± 1.0 cm, respectively. At final follow-up, 3 hips (10.0%) required revision: one (3.3%) for aseptic loosening and 2 (6.7%) for instability. No patients had progressive radiolucent lines at final follow-up. Five-year survival with aseptic loosening and all-cause revision as endpoints was 100% (95% confidence interval: 90.0%-100.0%) and 92.1% (95% confidence interval: 81.3%-100.0%), respectively. One patient required revision for aseptic loosening after the 5-year mark. Conclusions Trabecular metal augmentation during primary THA demonstrates satisfactory early to mid-term outcomes. TMA is a viable option for complex primary THA when bone loss is encountered or secondary support is required. Level of Evidence Level IV.
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Affiliation(s)
- Brian C. Chung
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nathanael D. Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Matthew C. Gallo
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Thomas Steck
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Christian Jimenez
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Daniel A. Oakes
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Sanghavi SA, Paprosky WG, Sheth NP. Evaluation and Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty: A 10-year Update. J Am Acad Orthop Surg 2024; 32:e466-e475. [PMID: 38412446 DOI: 10.5435/jaaos-d-23-00645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery. The use of cemented reconstruction techniques has declined, and contemporary practice trends have involved the increasing use of highly porous hemispherical shells in conjunction with modular porous metal augments, which can successfully treat most acetabular revisions. Noncemented treatment options for the management of acetabular bone loss during revision include conventional porous/modular highly porous hemispherical implants, nonmodular highly porous implants with cementable acetabular liners, cup-cage reconstruction, oblong cups, and triflange reconstruction. These options can be combined with modular porous metal augments, structural allografts, impaction grafting, or reconstruction cages. Acetabular distraction is a newer technique for chronic pelvic discontinuity, which is used in conjunction with off-the-shelf revision acetabular shells and modular porous metal augments. This review is an update over the past decade, highlighting studies with mid to long-term follow-up, and presents the advantages, disadvantages, and principles associated with each of the most commonly used reconstructive techniques.
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Affiliation(s)
- Sahil A Sanghavi
- From the Department of Arthroplasty, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India (Sanghavi), Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL (Paprosky), Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA (Sheth)
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11
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Akbulut D, Coşkun M, Alpay Y, Mirzazada J. Treatment of hip instability after total hip replacement with pelvic osteotomy using a modified Stoppa approach. Int J Surg Case Rep 2024; 118:109579. [PMID: 38583280 PMCID: PMC11015443 DOI: 10.1016/j.ijscr.2024.109579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Hip dislocation remains a significant complication following total hip arthroplasty, even though its incidence has decreased. While closed reduction is typically performed for early dislocations, delayed or chronic dislocations often necessitate acetabular or femoral component revision. CASE PRESENTATION This document describes the treatment of hip dislocation in a 56-year-old patient through pelvic osteotomy without component revision. An acetabular component malposition was identified, exhibiting an 80-degree inclination and 20-degree cup anteversion. Owing to limited bone stock, a modified Stoppa approach was used for pelvic osteotomy to reduce acetabular inclination. The patient displayed remarkable clinical improvement, achieving a Harris Hip Score of 85 at the two-year check-up with no signs of dislocation. CLINICAL DISCUSSION Recurrent hip dislocation is difficult to manage. It frequently necessitates component revision, presenting a challenge due to issues with cup extraction and limited bone stock. Preoperative detection of loosened components is crucial. If it goes undetected, the extraction process can result in bone loss, potentially leading to pelvic insufficiency. CONCLUSION Successful revisions of hip arthroplasties can be achieved with geometric modifications to the pelvis.
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Affiliation(s)
| | | | - Yakup Alpay
- Istanbul Baltalimani Metin Sabanci Osteopathic Training And Research Hospital, Turkey
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12
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Moharrami A, Mirghaderi P, Moazen-Jamshidi MM, Hoseini Zare N, Sharifpour S, Mortazavi SMJ. Bilateral total hip arthroplasty in a case with fibrous dysplasia: a case report. J Med Case Rep 2023; 17:371. [PMID: 37644615 PMCID: PMC10466812 DOI: 10.1186/s13256-023-04084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a benign neoplasm with a broad spectrum of presentations. The treatment of FD in the hip region is controversial among orthopedic surgeons. Several treatment options exist, including curettage and grafting, valgus osteotomy, medial displacement osteotomy, and so on. Performing total hip arthroplasty (THA) on these patients and their subsequent outcome is still in infancy. CASE PRESENTATION The patient is a 32-year-old white female with bilateral proximal femur FD who underwent bilateral THA with long stem implants. A year following surgery, she had no complications and had satisfactory radiological, pain, and functional outcomes. CONCLUSION A bilateral THA with a long stem prosthesis showed promising results when performed following appropriate curettage of the proximal bone in an FD case. A cementless long stem could have enabled better diaphyseal fixation distal to the lesion site.
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Affiliation(s)
- Alireza Moharrami
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran
| | - Peyman Mirghaderi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran
- Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Mansour Moazen-Jamshidi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran
| | - Nima Hoseini Zare
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran
| | - Sadula Sharifpour
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran
| | - S M Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, Iran.
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13
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Di Laura A, Henckel J, Hart A. Custom 3D-Printed Implants for Acetabular Reconstruction: Intermediate-Term Functional and Radiographic Results. JB JS Open Access 2023; 8:e22.00120. [PMID: 37197697 PMCID: PMC10184995 DOI: 10.2106/jbjs.oa.22.00120] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The management of massive acetabular defects at the time of revision hip surgery is challenging. Severe pelvic bone loss and the heterogeneity and quality of the remaining bone stock can compromise the fixation and mechanical stability of the implant. Methods We reviewed a database of consecutive patients who had undergone acetabular reconstruction with the use of a custom 3D-printed implant with a dual-mobility bearing for the treatment of Paprosky type-3B defects between 2016 and 2019. Functional and radiological outcomes were assessed. Results A total of 26 patients (17 women and 9 men) with a minimum follow-up of 36 months (median, 53 months; range, 36 to 77 months) were identified. The median age at surgery was 69 years (range, 49 to 90 years), and 4 patients had pelvic discontinuity. The cumulative implant survivorship was 100%. The median Oxford Hip Score improved significantly from 8 (range, 2 to 21) preoperatively to 32 (range, 14 to 47) postoperatively (p = 0.0001). One patient had a transient sciatic nerve palsy, 1 hip dislocated 6 months postoperatively and was managed nonoperatively, and 1 infection recurred. No patient had a fracture. Radiographic evaluation showed bone ingrowth at the bone-implant interface in 24 patients (92%) at ≥12 months of follow-up and showed no evidence of implant loosening or migration at the latest follow-up (3 to 6 years). Conclusions Excellent functional improvement, implant survivorship, and osseointegration were recorded in the patient cohort. Accurate preoperative planning and the adoption of custom 3D-printed implants showed promising results in complex revision hip surgery. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anna Di Laura
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
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14
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Kaplan NB, Barra MF, Jubril A, Knapp E, Awad H, Ginnetti J. Effects of Acetabular Screws on the Initial Stability of Porous Coated Acetabular Implants in Revision Total Hip Arthroplasty. Cureus 2023; 15:e38257. [PMID: 37252568 PMCID: PMC10225166 DOI: 10.7759/cureus.38257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty in the setting of acetabular bone loss remains a challenging clinical entity. Deficiencies of the acetabular rim, walls, and/or columns may limit the bony surface area and initial acetabular construct stability necessary for osseointegration of cementless components. Press-fit acetabular components with supplemental acetabular screw fixation represent a common technique aimed to minimize implant micromotion and allow for definitive osseointegration. Although acetabular screw fixation is commonly practiced in revision hip arthroplasty, few studies to date have examined the screw properties associated with maximal acetabular construct stability. The purpose of the present report is to examine acetabular screw fixation in a pelvis model mimicking Paprosky IIB acetabular bone loss. METHODS Measuring bone-implant interface micromotion as a surrogate for initial implant stability, experimental models assessed the effect of screw number, screw length, and screw position on construct stability subject to a cyclic loading protocol designed to replicate joint reaction forces of two common daily activities. RESULTS Trends towards increasing stability were demonstrated with increasing screw number, increasing screw length, and concentrating screws in the supra-acetabular dome. All experimental constructs yielded micromotion levels sufficient for bone ingrowth, except when screws in the dome were moved to the pubis and ischium. CONCLUSIONS When using a porous coated revision acetabular implant to treat Paprosky IIB defects, screws should be used, and furthermore, increasing number, length, and position within the acetabular dome may help further stabilize the construct.
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Affiliation(s)
- Nathan B Kaplan
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Matthew F Barra
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Ayodeji Jubril
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Emma Knapp
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, USA
| | - Hani Awad
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research/Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, USA
| | - John Ginnetti
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
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Kuijpers MFL, Hannink G, van Steenbergen LN, Schreurs BW. A significant change towards cemented fixation in revision total hip arthroplasty in patients younger than 55 years in the Netherlands: results of an observational cohort study in the Dutch Arthroplasty Register in 28,516 primary hip replacements and 1285 revision procedures. Hip Int 2023; 33:288-297. [PMID: 34102901 PMCID: PMC9978863 DOI: 10.1177/11207000211020002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Worldwide, the majority of total hip arthroplasties (THAs) placed in patients <55 years are uncemented. However, little is known about the preferred method of fixation in revision hip arthroplasty in young patients. The aim of this study was to assess potential differences in the method of fixation used between primary and revision THA in young patients using data from the Dutch Arthroplasty Register. METHODS All primary THA placed in patients younger than 55 years, registered in the LROI between 2007 and 2019 were included n = 28,516). Kaplan-Meier survival analyses were used to estimate the survival of primary THA by method of fixation. Additionally, survival of revision procedures that changed or did not change in method of fixation were estimated. McNemar's test was used to assess differences in the proportion of cemented and uncemented fixation between primary and revision THA. RESULTS In all acetabular revisions, the use of cemented fixation increased statistically significant with 39% (95% CI, 34-45, p < 0.001) from 23% in primary THA to 62% in revision procedures. In all femoral revisions, the increase of cemented fixation was also statistically significant with 25% (95% CI, 19-31, p < 0.001), from 11% in primary THA to 36% in revision surgery. For both revised acetabular and femoral components, we found no statistically significant difference in the 5-year survival between revision procedures that changed or did not change in method of fixation. CONCLUSIONS There was a significant change towards cemented fixation between primary and revision THA in young patients in the Netherlands, which was especially pronounced in acetabular revisions. No significant difference in short-term survival was found between revision procedures that changed or did not change in method of fixation. Long-term follow-up data are needed to evaluate the effect of this change in fixation method on the outcome of revision procedures in young patients.
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Affiliation(s)
- Martijn FL Kuijpers
- Department of Orthopaedics, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands,Martijn FL Kuijpers, Radboud University
Medical Centre, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register (Landelijke
Registratie Orthopedische Implantaten), ‘s-Hertogenbosch, The Netherlands
| | - B Wim Schreurs
- Department of Orthopaedics, Radboud
Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The
Netherlands,Dutch Arthroplasty Register (Landelijke
Registratie Orthopedische Implantaten), ‘s-Hertogenbosch, The Netherlands
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16
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Meynen A, Vles G, Roussot M, Van Eemeren A, Wafa H, Mulier M, Scheys L. Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects. Arch Orthop Trauma Surg 2023; 143:1611-1617. [PMID: 35149888 DOI: 10.1007/s00402-022-04372-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Classifying complex acetabular defects in revision total hip arthroplasty (THA) by means of conventional radiographs comes with significant limitations. Statistical shape modelling allows the virtual reconstruction of the native pelvic morphology, hereby enabling an analytic acetabular defect assessment. Our objective was to evaluate the effect of advanced imaging augmented with analytic representations of the defect on (1) intra- and inter-rater reliability, and (2) up- or downscaling of classification scores when evaluating acetabular defects in patients undergoing revision THA. MATERIALS AND METHODS The acetabular defects of 50 patients undergoing revision THA were evaluated by three independent, fellowship-trained orthopaedic surgeons. Defects were classified according to the acetabular defect classification (ADC) using four different imaging-based representations, namely, standard radiographs, CT imaging, a virtual three-dimensional (3D) model and a quantitative analytic representation of the defect based on a statistical shape model reconstruction. Intra- and inter-rater reliabilities were quantified using Fleiss' and Cohen's kappa scores, respectively. Up- and downscaling of classification scores were compared for each of the imaging-based representations and differences were tested. RESULTS Overall inter-rater agreement across all imaging-based representations for the classification was fair (κ 0.29 95% CI 0.28-0.30). Inter-rater agreement was lowest for radiographs (κ 0.21 95% CI 0.19-0.22) and increased for other representations with agreement being highest when using analytic defect models (κ 0.46 95% CI 0.43-0.48). Overall intra-rater agreement was moderate (κ 0.51 95% CI 0.42-0.60). Intra-rater agreement was lowest for radiographs (κ 0.40 95% CI 0.23-0.57), and highest for ratings including analytic defect models (κ 0.64:95% CI 0.46-0.82). Virtual 3D models with quantitative analytic defect representations upscaled acetabular defect scores in comparison to standard radiographs. CONCLUSIONS Using 3D CT imaging with statistical shape models doubles the intra- and inter-rater reliability and results in upscaling of acetabular defect classification when compared to standard radiographs. This method of evaluating defects will aid in planning surgical reconstruction and stimulate the development of new classification systems based on advanced imaging techniques.
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Affiliation(s)
- Alexander Meynen
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Georges Vles
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Mark Roussot
- Department of Trauma and Orthopaedics, University College Hospital London, London, NW1 2BU, UK
| | - Anthony Van Eemeren
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hazem Wafa
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michiel Mulier
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lennart Scheys
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Herestraat 49, 3000, Leuven, Belgium.,Division of Orthopaedics, Gasthuisberg, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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17
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Romagnoli M, Casali M, Zaffagnini M, Cucurnia I, Raggi F, Reale D, Grassi A, Zaffagnini S. Tricalcium Phosphate as a Bone Substitute to Treat Massive Acetabular Bone Defects in Hip Revision Surgery: A Systematic Review and Initial Clinical Experience with 11 Cases. J Clin Med 2023; 12:jcm12051820. [PMID: 36902607 PMCID: PMC10003370 DOI: 10.3390/jcm12051820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/28/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
The use of tricalcium phosphate (TCP) as a bone substitute is gaining increasing interest to treat severe acetabular bone defects in revision total hip arthroplasty (rTHA). The aim of this study was to investigate the evidence regarding the efficacy of this material. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the modified Coleman Methodology Score (mCMS) for all studies. A total of eight clinical studies (230 patients) were identified: six on TCP used as biphasic ceramics composed of TCP and hydroxyapatite (HA), and two as pure-phase ceramics consisting of TCP. The literature analysis showed eight retrospective case series, of which only two were comparative studies. The mCMS showed an overall poor methodology (mean score 39.5). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results. A total of 11 cases that underwent rTHA with a pure-phase ceramic presented satisfactory clinical and radiological outcomes at initial short-term follow-up. Further studies at long-term follow-up, involving a larger number of patients, are needed before drawing more definitive conclusions on the potential of TCP for the treatment of patients who undergo rTHA.
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Affiliation(s)
- Matteo Romagnoli
- Ortopedia e Traumatologia Rizzoli Argenta, 44011 Argenta, FE, Italy
| | - Marco Casali
- Ortopedia e Traumatologia Rizzoli Argenta, 44011 Argenta, FE, Italy
- Correspondence:
| | - Marco Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy
| | - Ilaria Cucurnia
- Ortopedia e Traumatologia Rizzoli Argenta, 44011 Argenta, FE, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy
| | - Davide Reale
- Ortopedia e Traumatologia Rizzoli Argenta, 44011 Argenta, FE, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, BO, Italy
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Taheriazam A, Saeidinia A. Evaluation results of using GAP II acetabular cage for acetabulum in revision total hip arthroplasty. Medicine (Baltimore) 2022; 101:e32056. [PMID: 36451475 PMCID: PMC9704984 DOI: 10.1097/md.0000000000032056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acetabular revision arthroplasty with major bone loss is one of the most difficult operations in hip arthroplasty, The graft augmentation prosthesis (GAP) has been designed particularly as an implant for revision acetabular reconstruction. We evaluated the use of GAP II acetabular cage in revision of acetabulum in total hip arthroplasty. From 2009 to 2014, we performed revision total hip arthroplasty in patients with acetabular defects by cage (GAP II) in patients referred to Milad and Erfan Hospitals, Tehran, Iran. We included all patients in class 3a and 3b of Paprosky bone loss classification and type III bone loss according to the system of the American Academy of Orthopedic Surgeons. We used SPSS software Ver 19 and descriptive tests, Chi square and independent t-test were used for analysis. There were 221 men (71.99%) and 86 women (28.01%) with an average age of 51.3 ± 21.7 years (range, 35-86 years). The Modified Harris Hip Score (MHHS) improved significantly at the last follow-up compared with the preoperative MHHS (P < .001). The mean MHHS was 40 (range, 29-44) preoperatively and 92 (range, 86-95) at the last follow-up. There were no major intraoperative complications during acetabular reconstruction. Our findings showed that using GAP II acetabular cage in the restoration of acetabulum in hip revision surgery is significantly desirable.
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Affiliation(s)
- Afshin Taheriazam
- Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
- * Correspondence: Afshin Taheriazam and Amin Saeidinia, Tehran Medical Branch, Islamic Azad University, Khaghani St, Shariati Ave, Tehran, IranMashhad University of Medical Sciences, Mashhad, Iran (e-mail: ; )
| | - Amin Saeidinia
- Mashhad University of Medical Sciences, Mashhad, Iran
- * Correspondence: Afshin Taheriazam and Amin Saeidinia, Tehran Medical Branch, Islamic Azad University, Khaghani St, Shariati Ave, Tehran, IranMashhad University of Medical Sciences, Mashhad, Iran (e-mail: ; )
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19
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Lucero CM, García-Mansilla A, Albani Forneris A, Díaz Dilernia F, Slullitel P, Zanotti G, Comba F, Piccaluga F, Buttaro M. Secuenciación de próxima generación para la detección de patógenos en cirugía de cadera: experiencia y viabilidad diagnóstica en un centro de atención terciaria de la Argentina. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.5.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introducción: El diagnóstico rápido y definitivo con identificación del patógeno es fundamental cuando hay una infección periprotésica. La secuenciación de próxima generación permite identificar el ADN en un germen determinado en poco tiempo. Hasta donde sabemos, no hay reportes sobre su empleo para el manejo de la infección periprotésica en Sudamérica. Nuestro objetivo fue demostrar la viabilidad diagnóstica de las muestras obtenidas de una serie de pacientes operados en Buenos Aires, Argentina, y analizadas con la técnica de secuenciación de próxima generación.
Materiales y Métodos: Se analizó a una serie prospectiva de 20 pacientes sometidos a cirugía de revisión séptica y aséptica de cadera desde diciembre de 2019 hasta marzo de 2020. Se obtuvieron muestras intraoperatorias de líquido sinovial, tejido profundo y canal endomedular, que fueron enviadas para su análisis al laboratorio NexGen Microgen.
Resultados: Se seleccionaron 17 pacientes, porque tenían una muestra apta para analizar. Los resultados se recibieron dentro de las 72 h de la cirugía. En un caso, el resultado de la secuenciación de próxima generación informó un germen distinto del identificado en los cultivos posoperatorios de partes blandas, esto permitió corregir la antibioticoterapia. En otro, esta técnica identificó Parabacteroides gordonii en una revisión aséptica, en otro, Morganella morganii, a partir de cultivos negativos en una revisión en un tiempo.
Conclusión: Se demostró la viabilidad diagnóstica con la secuenciación de próxima generación, se pueden obtener resultados de microorganismos patógenos dentro de las 72 h posteriores a la cirugía en pacientes con infección periprotésica y cultivos negativos.
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20
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Wang Q, Wang Q, Liu P, Ge J, Zhang Q, Guo W, Wang W. Clinical and radiological outcomes of jumbo cup in revision total hip arthroplasty: A systematic review. Front Surg 2022; 9:929103. [PMID: 36268211 PMCID: PMC9577022 DOI: 10.3389/fsurg.2022.929103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Many studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis. Results A total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm. Conclusion A jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.
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Affiliation(s)
- Qiuyuan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qi Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Department of Orthopaedic Surgery, Peking University of China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Pei Liu
- Department of Adult Joint Reconstruction, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Department of Orthopaedic Surgery, Peking University of China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Correspondence: Weiguo Wang Wanshou Guo
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Correspondence: Weiguo Wang Wanshou Guo
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21
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Kaiser D, Ried E, Zingg PO, Rahm S. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 2022; 142:2957-2964. [PMID: 34581861 PMCID: PMC9474438 DOI: 10.1007/s00402-021-04187-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. METHODS A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. RESULTS 24 patients (29 hips) with a mean age of 43 (18-75) years and a mean follow-up of 35 months (12-137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0-23) and significantly medialized by a mean of 18 mm (6-29). The bone graft was fully integrated after 12 months in all cases. CONCLUSION Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Emanuel Ried
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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22
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Xing D, Li R, Li JJ, Tao K, Lin J, Yan T, Zhou D. Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review. Orthop Surg 2022; 14:1918-1926. [PMID: 35819098 PMCID: PMC9363776 DOI: 10.1111/os.13322] [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: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Periprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally. CASE PRESENTATION A 52-year-old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers. CONCLUSION Inflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long-term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Rujun Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ke Tao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Diange Zhou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
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Acetabular Reconstruction Using Multiple Porous Tantalum Augments: Three-Quarter Football Augment. Case Rep Orthop 2022; 2022:7954052. [PMID: 35637771 PMCID: PMC9148226 DOI: 10.1155/2022/7954052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Reconstruction of a large acetabular bone defect is a complex problem in revision hip arthroplasty. The authors report a novel method of reconstructing an uncontained acetabular defect (Paprosky type IIIb) using multiple tantalum augments. A 73-year-old female patient presented to our institution with a chronically dislocated primary left total hip arthroplasty with radiographs demonstrating migration of acetabular component and formation of pseudoarthrosis within the left ilium. Extensive arthrolysis and anatomic reconstruction of the acetabular bone defect were performed using the novel method of multiple tantalum augments. Postoperatively, recovery was initially complicated by multiple dislocations requiring an exchange to an elevated liner, however subsequently achieved good function.
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24
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Zhang J, Hu Y, Ying H, Mao Y, Zhu Z, Li H. Reliability and validity test of a novel three-dimensional acetabular bone defect classification system aided with additive manufacturing. BMC Musculoskelet Disord 2022; 23:432. [PMID: 35534887 PMCID: PMC9082860 DOI: 10.1186/s12891-022-05365-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/25/2022] [Indexed: 01/18/2023] Open
Abstract
Background Accurate assessment of acetabular defects and designing precise and feasible surgical plans are essential for positive outcomes of hip revision arthroplasty. Additive manufacturing (AM) is a novel technique to print physical object models. We propose a three-dimensional acetabular bone defect classification system aided with AM model, and further assess its reliability and validity under blinded conditions. Methods We reviewed 104 consecutive patients who underwent hip revision arthroplasty at our department between January 2014 and December 2019, of whom 45 had AM models and were included in the reliability and validity tests. Three orthopedic surgeons retrospectively evaluated the bone defects of these 45 patients with our proposed classification, made surgical plans, and repeated the process after 2 weeks. The reliability and validity of the classification results and corresponding surgical plans were assessed using the intra-class correlation coefficient or kappa correlation coefficient. Results The reliability and validity of the classification results were excellent. The mean initial intra-class correlation coefficient for inter-observer reliability was 0.947, which increased to 0.972 when tested a second time. The intra-observer reliability ranged from 0.958 to 0.980. Validity of the classification results also showed a high kappa correlation coefficient of 0.951–0.967. When considering corresponding surgical plans, the reliability and validity were also excellent, with intra-class correlation coefficients and kappa correlation coefficients measuring all over 0.9. Conclusions This three-dimensional acetabular defect classification has excellent reliability and validity. Using this classification system and AM models, accurate assessment of bone defect and reliable surgical plans could be achieved. This classification aided with AM is a promising tool for surgeons for preoperative evaluation.
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Affiliation(s)
- Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Yi Hu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Hua Ying
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Yuanqing Mao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Zhenan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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25
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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: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
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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
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Garala K, Boutefnouchet T, Amblawaner R, Lawrence T. Acetabular reconstruction using a composite layer of impacted cancellous allograft bone and cement: minimum 5-year follow-up study. Hip Int 2022; 32:197-204. [PMID: 32678673 DOI: 10.1177/1120700020941407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is often complex and has a less reliable outcome than primary total hip arthroplasty. Acetabular reconstruction remains a challenge because of the variable amount of bone loss. This study describes and evaluates a novel technique of acetabular reconstruction using composite bone grafting. PATIENTS AND METHODS Between June 2005 and January 2012, 108 consecutive patients underwent revision hip arthroplasty in which the acetabular component was revised using composite bone grafting. Of these, 24 were lost to follow-up leaving 84 in the study with a minimum 5-year follow-up. There were 54 women and 30 men with a mean age of 70.1 (31-91) years. All patients were assessed clinically and radiologically after a minimum of 5 years. The primary outcome measures were rate of re-revision, patient-reported outcomes and radiological evidence of loosening. RESULTS The mean follow-up after revision surgery was 6.9 years (5-10). At operation, 60 patients had an acetabular defect of AAOS stage 3 or more. There was no evidence of loosening in 69 revision acetabular components; 12 showed evidence of non-progressive loosening and 3 patients underwent a re-revision procedure (2 for infection, 1 recurrent dislocation).The mean postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) was 89.11/100 (95% CI, 87.8-90.5). Scores were significantly improved in patients with a more extensive preoperative defect (p = 0.006). The overall patient satisfaction rate at final follow-up was very high. CONCLUSIONS Composite impaction grafting using a layered cement and bone graft technique can give satisfactory clinical and radiological outcomes in the medium- to long-term.
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Affiliation(s)
- Kanai Garala
- Trauma and Orthopaedic Department, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Tarek Boutefnouchet
- Trauma and Orthopaedic Department, Birmingham Heartlands Hospital, Birmingham, UK
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27
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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: 18] [Impact Index Per Article: 6.0] [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.
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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
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Innocenti M, Muratori F, Mazzei G, Guido D, Frenos F, Lucenteforte E, Capanna R, Campanacci DA. The use of a non-biological, bridging, antiprotrusio cage in complex revision hip arthroplasty and periacetabular reconstructive oncologic surgery. Is still today a valid option?: A mid/long-term survival and complications' analysis. Arch Orthop Trauma Surg 2022; 142:681-690. [PMID: 34028571 PMCID: PMC8924141 DOI: 10.1007/s00402-021-03929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Burch-Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages' failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked. MATERIALS AND METHODS We evaluated 73 patients who received a B-SlAC from January 2008 to January 2018. Group A, 40 oncological cases (22 primary tumors; 18 metastases); Group B, 33 failed THAs. We compared both Kaplan-Meier estimates of risk of failure and complication with the cumulative incidence function, taking account the competing risk of death. Cox proportional hazards model was utilized to identify possible predictors of instability and infection. Harris hip score HHS was used to record clinical outcomes. RESULTS Medium follow-up was 80 months (24-137). Average final HHS was 61 (28-92), with no differences within the two groups (p > 0.05). The probabilities of failure and complications were 57% and 26%, respectively, lower in the oncologic group than in the rTHA group (p =0 .176; risk 0.43) (p = 0.52; risk 0.74). Extended ileo-femoral approach and proximal femur replacement (p =0.02, risk ratio = 3.2; p = 0.04, rr = 2.1) were two significant independent predictors for dislocations, while belonging to group B (p = 0.04, rr = 2.6) was predictable for infections. CONCLUSION Burch-Schneider-like antiprotrusio cages are a classical non-biological acetabular reconstruction method that surgeons should bear in mind when facing gross periacetabular bone losses, independently of their cause. However, dislocation and infection rates are high. Whenever possible, we suggest preserving the proximal femur in revision THA, and to use a less-invasive postero-lateral approach to reduce dislocation rates in non-oncologic cases.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Giacomo Mazzei
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Davide Guido
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
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Tikhilov RM, Dzhavadov AA, Kovalenko AN, Bilyk SS, Denisov AO, Shubnyakov II. Standard Versus Custom-Made Acetabular Implants in Revision Total Hip Arthroplasty. J Arthroplasty 2022; 37:119-125. [PMID: 34598861 DOI: 10.1016/j.arth.2021.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Today, various options are used for the reconstruction of acetabular bone loss in revision total hip arthroplasty (RTHA). The aim of the study was to compare the outcomes of using standard acetabular implants (SAIs) and custom-made acetabular implants (CMAIs) in RTHA in cases with extensive acetabular bone loss. METHODS This was a comparative analysis of the results of 106 operations of RTHA performed during the period from January 2013 to December 2019. In 61 cases (57.5%), CMAIs were used. In 45 cases (42.5%), SAIs were implanted. RESULTS The incidence of aseptic loosening of the acetabular component after RTHA in uncontained loss of bone stock of the acetabulum (type III-IV as per the Gross and Saleh classification) using the CMAI was less than that using the SAI (2.4% and 10.0%, respectively). The most significant differences in aseptic loosening rates were noted after implantation of the CMAI and SAI in pelvic discontinuity with uncontained bone defect (0% and 60.0%, respectively; P<.001). CONCLUSION The ideal indications for the use of the CMAI are uncontained defects and pelvic discontinuity with uncontained loss of bone stock (types III-V Gross and Saleh classification). Treatment of these defects with the SAI leads to a higher incidence of aseptic loosening requiring re-revisions. Further observation is required to assess the effectiveness of using the CMAI and SAI in the long-term follow-up period.
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Affiliation(s)
- Rashid M Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alisagib A Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Anton N Kovalenko
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Stanislav S Bilyk
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alexey O Denisov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Igor I Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
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30
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van der Merwe JF, Erasmus LJ, van der Merwe W, Ellis JA. Obtaining optimum screw placement for revision acetabular prostheses using the sciatic notch as reference. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2021.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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De Pieri E, Atzori F, Ferguson SJ, Dendorfer S, Leunig M, Aepli M. Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation. Hip Int 2021; 31:624-631. [PMID: 32343622 DOI: 10.1177/1120700020917321] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity. METHODS Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction. RESULTS Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius). CONCLUSIONS In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved.
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Affiliation(s)
- Enrico De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, ZH, Switzerland
| | - Federica Atzori
- Institute for Biomechanics, ETH Zurich, Zurich, ZH, Switzerland
| | | | | | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Martin Aepli
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
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Zhang JW, Liu XL, Zeng YM, Zhai ZJ, Mao YQ, Yu DG, Wang L, Yan MN, Zhu ZN, Li HW. Comparison of 3D Printing Rapid Prototyping Technology with Traditional Radiographs in Evaluating Acetabular Defects in Revision Hip Arthroplasty: A Prospective and Consecutive Study. Orthop Surg 2021; 13:1773-1780. [PMID: 34409750 PMCID: PMC8523770 DOI: 10.1111/os.13108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/02/2021] [Accepted: 05/23/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To compare rapid prototyping technology (RP tech) in revision total hip arthroplasty (RTHA) with traditional examination methods and to see how they are different in evaluating acetabular anatomy and designing surgical procedure. Methods From February 2014 to March 2018, 43 RTHA patients with complex acetabulum defects were enrolled in this prospective study regardless of age or gender. Incomplete and unclear data were excluded. Three types of radiographic examination were performed on each patient before the revision surgery. Four groups of evaluations were designed: (i) X‐ray; (ii) computed tomography (CT‐scan); (iii) RP tech; and (iv) CT‐aided RP tech. Discrepancies between preoperative radiographic analysis and intra‐operative findings were separately compared by a team of surgeons. Premade surgical plans based on each evaluation method were compared with the final surgical procedure. The compliance of anatomic evaluation and surgical plan‐design based on 3D RP tech and traditional radiographs were ranked manually by a of team surgeons into: (i) complete accordance; (ii) general accordance; and (iii) undetermined structure/procedure. The difference in ranks between RP tech and traditional radiographic methods were analyzed with a nonparametric Kruskal‐Wallis test. P < 0.05 was considered significant. Multiple adjustments were taken for the statistical tests level according to the Bonferroni method. Results For anatomic analysis, the accordance in four groups of evaluating methods differed from each other (P < 0.05) except for the comparison of RP tech and CT‐aided RP tech. RP tech displayed better anatomic evaluating accuracy than traditional methods (X‐ray and CT) with the “complete accordance” rates of these groups being 88.37%, 4.65% and 27.91%, respectively. But CT‐aided RP tech did not improve accuracy significantly compared with using RP tech individually, although the value seems high in the CT‐aided RP group with the “complete accordance” rate of 95.35%. For surgery design, RP tech significantly showed better applicable surgical design compared with X‐ray and CT (P < 0.05), and the “complete accordance” rates were 88.37%, 6.98% and 23.26%, but no significant difference was observed between RP tech and CT‐aided RP tech, and the “complete accordance” rate of CT‐aided RP tech group was 97.67%. RP tech showed remarkable improvement in bone defect assessment and surgical plan design. Conclusion Using RP technology improved both sensibility and accuracy in acetabular defect evaluation with better locating and evaluating efficiency compared with X‐ray and CT‐scans. It also improved surgical schedule designing in complex acetabular defecting revision surgery. In particularly complex cases, CT aided RP tech may increase the accuracy of RP tech.
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Affiliation(s)
- Jing-Wei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Liang Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Ming Zeng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zan-Jing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuan-Qing Mao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De-Gang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meng-Ning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhe-Nan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui-Wu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Yishake M, Tang L, Chen X, Wang Y, He R. Partial two-stage exchange: an alternative method for infected total hip arthroplasty. BMC Musculoskelet Disord 2021; 22:686. [PMID: 34384393 PMCID: PMC8361613 DOI: 10.1186/s12891-021-04550-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/12/2021] [Indexed: 01/16/2023] Open
Abstract
Background Total two-stage exchange is commonly used in clinical practice as a treatment for infected total hip arthroplasty (THA); however, this approach involves considerable limitations, including significant bone loss and severe trauma. This retrospective cohort study was conducted to evaluate clinical outcomes following the use of partial two-stage exchange (PTE) for infected THA. Methods We performed a retrospective analysis of 28 patients with infected THA who were treated by PTE between September 2000 and June 2019. Eligibility for PTE was limited to patients with a well-fixed femoral stem prosthesis. In the first stage of the operation, the femoral stem prosthesis was preserved; subsequently, the acetabular prosthesis, liner, and head were replaced with an antibiotic-loaded spacer. The new prosthesis was then implanted into patients and monitored for at least 3 months to ensure freedom from infection. Results Patients were followed for an average of 4 years (range, 2–11 years), with an overall success rate of 85.7% (24/28). The mean Harris hip score at the final follow-up was 76.2 ± 11.7 points. Conclusions The findings of this study suggest that PTE could be an acceptable option for a subset of patients with infected THA, offering a satisfactory infection control rate and clinical outcomes comparable to those of total two-stage exchange, but with less harm.
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Affiliation(s)
- Mumingjiang Yishake
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China.,Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
| | - Lan Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
| | - Xi Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.,Department of Public Health, Zhejiang University, Zhejiang, Hangzhou, China
| | - Yuejian Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
| | - Rongxin He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Zhejiang, 310009, Hangzhou, China.
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Kawalkar AC, Kalanie A, Neil MJ. Excellent Midterm Results of Triflange Patient Matched Implants for Extensive Acetabular Bone Defect. Hip Pelvis 2021; 33:87-95. [PMID: 34141695 PMCID: PMC8190502 DOI: 10.5371/hp.2021.33.2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Reconstruction of extensive acetabular bone defects is one of the most challenging problems encountered by arthroplasty surgeons. Triflange patient matched implants (PMI) offer the potential advantages of immediate, rigid fixation with a superior individualized fit. The purpose of this study was to evaluate the clinical and radiographic midterm results of PMI in extensive acetabular defect reconstruction. Materials and Methods The current prospectively designed retrospective review examined 13 consecutive patients (5 males and 8 females) with a mean age of 69 years undergoing revision hip arthroplasty with Paprosky type 3B acetabular defects reconstructed using PMI between October 2011 and December 2016. A successful result was defined as a postoperative increase in Harris hip score (HHS) of >20 points with a radiographically stable implant (assessed with hip X-rays) and no need for additional acetabular reconstruction. Results Twelve out of the 13 patients in the study were available for follow-up with mean duration of 50 months. One patient died during the study period due to an unrelated cause. The mean HHS increased from 41 to 82 points. Eleven out of 12 acetabular components were well fixed and pelvic discontinuity healed in all patients. Conclusion Custom triflange PMI is an excellent option for management of complex and extensive acetabular defects with or without pelvic discontinuity.
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Affiliation(s)
- Abhijit C Kawalkar
- Department of Orthopedic Surgery, Orange City Hospital and Research Institute, Nagpur, India
| | - Amir Kalanie
- Department of Orthopedic Surgery, St. Vincent's Bone and Joint Unit, St. Vincent's Private Hospital Sydney, Darlinghurst, Sydney, Australia
| | - Micheal J Neil
- Department of Orthopedic Surgery, St. Vincent's Bone and Joint Unit, St. Vincent's Private Hospital Sydney, Darlinghurst, Sydney, Australia
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Scharff-Baauw M, Van Hooff ML, Van Hellemondt GG, Jutte PC, Bulstra SK, Spruit M. Good results at 2-year follow-up of a custom-made triflange acetabular component for large acetabular defects and pelvic discontinuity: a prospective case series of 50 hips. Acta Orthop 2021; 92:297-303. [PMID: 33583339 PMCID: PMC8237836 DOI: 10.1080/17453674.2021.1885254] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Custom triflange acetabular components (CTACs) are suggested as good solutions for large acetabular defects in revision total hip arthroplasty. However, high complication rates have been reported and most studies are of limited quality. This prospective study evaluates the performance of a CTAC in patients with large acetabular defects including pelvic discontinuity.Patients and methods - Prospectively collected data of 49 consecutive patients (50 hips), who underwent an acetabular revision with a CTAC were analyzed. Follow-up (FU) was 2 years. The median age of the patients was 68 years (41-89) and 41 were women. Primary outcomes were re-revision of the CTAC and differences between the modified Oxford Hip Score (mOHS) preoperatively and at 2-year follow-up. Secondary outcomes included several patient-reported outcomes (PROMs), radiological results, complications, and a comparison between hips with and without pelvic discontinuity (PD).Results - 1 patient (1 hip) was lost to the 2-year FU. No CTAC needed re-revision. The preoperative and 2-year FU mOHS were available in 40 hips and improved statistically significantly. All of the other secondary outcomes improved over time. 5 hips (of 45 with radiological 2-year FU) had loosening of screws. 8 hips had complications, including 3 persistent wound leakage, 3 pelvic fractures, and 1 dislocation. The mOHS and complication rate were similar in hips with and without PD.Interpretation - Reconstruction of large acetabular defects with and without PD with this CTAC showed good improvement in patient-reported daily functioning, high patient-reported satisfaction, few complications, and no re-revisions at 2-year FU.
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Affiliation(s)
- Marieke Scharff-Baauw
- Orthopaedic Department, Sint Maartenskliniek, Nijmegen; ,Orthopaedic Department, University Medical Centre Groningen; ,Orthopaedic Department, Medisch Centrum Leeuwarden, The Netherlands,Correspondence:
| | | | | | - Paul C Jutte
- Orthopaedic Department, University Medical Centre Groningen;
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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: 8] [Impact Index Per Article: 2.0] [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.
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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: 23] [Impact Index Per Article: 5.8] [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.
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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
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Kolken H, de Jonge C, van der Sloten T, Garcia AF, Pouran B, Willemsen K, Weinans H, Zadpoor A. Additively manufactured space-filling meta-implants. Acta Biomater 2021; 125:345-357. [PMID: 33618018 DOI: 10.1016/j.actbio.2021.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 12/30/2022]
Abstract
The unprecedented properties of meta-biomaterials could pave the way for the development of life-lasting orthopedic implants. Here, we used non-auxetic meta-biomaterials to address the shortcomings of the current treatment options in acetabular revision surgery. Due to the severe bone deficiencies and poor bone quality, it can be very challenging to acquire adequate initial implant stability and long-term fixation. More advanced treatments, such as patient-specific implants, do guarantee the initial stability, but are formidably expensive and may eventually fail due to stress shielding. We, therefore, developed meta-implants furnished with a deformable porous outer layer. Upon implantation, this layer plastically deforms into the defects, thereby improving the initial stability and homogeneously stimulating the surrounding bone. We first studied the space-filling behavior of additively manufactured pure titanium lattices, based on six different unit cells, in a compression test complemented with full-field strain measurements. The diamond, body-centered cubic, and rhombic dodecahedron unit cells were eventually selected for the design of the deformable porous outer layer. Each design came in three different relative density profiles, namely maximum (MAX), functionally graded (FG), and minimum (MIN). After their compression in bone-mimicking molds with simulated acetabular defects, the space-filling behavior of the implants was evaluated using load-displacement curves, micro-CT images, and 3D reconstructions. The meta-implants with an FG diamond infill exhibited the most promising space-filling behavior. However, the required push-in forces exceed the impact forces currently applied in surgery. Future research should, therefore, focus on design optimization, to improve the space-filling behavior and to facilitate the implantation process for orthopedic surgeons. STATEMENT OF SIGNIFICANCE: Ideally, orthopedic implants would last for the entire lifetime of the patient. Unfortunately, they rarely do. Critically sized defects are a common sight in the revision of acetabular cups, and rather difficult to treat. The permanent deformation of lattice structures can be used to create shape-morphing implants that would fill up the defect site, and thereby restore the physiological loading conditions. Bending-dominated structures were incorporated in the porous outer layer of the space-filling meta-implants for their considerable lateral expansion in response to axial compression. A functionally graded density offered structural integrity at the joint while enhancing the deformability at the bone-implant interface. With the use of a more ductile metal, CP-Ti, these meta-implants could be deformed without strut failure.
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Simon S, Frank BJH, Aichmair A, Dominkus M, Hofstaetter JG. Reconstruction of Proximal Metaphyseal Femoral Defects Using Trabecular Metal Augments in Revision Total Hip Arthroplasty. Arthroplast Today 2021; 8:216-221. [PMID: 33937461 PMCID: PMC8079334 DOI: 10.1016/j.artd.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
Porous tantalum augments are widely used in revision total hip arthroplasty for the reconstruction of severe bone defects. Here, we present the first 3 cases who underwent femoral revision arthroplasty using standard distal femoral and proximal tibial porous tantalum cones to reconstruct severe bone loss in the proximal femur. Cones were inserted press fit, followed by implantation of a cemented revision stem in all cases. After a mean follow-up period of 15.8 months, all patients showed an improved Harris-Hip-Score and no radiological signs of subsidence or loosening. Porous tantalum cones may be an option in the reconstruction of severe femoral defects in revision total hip arthroplasty. The shape of the tantalum cones should be optimized for the use in the proximal femur.
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Affiliation(s)
- Sebastian Simon
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Bernhard J H Frank
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Alexander Aichmair
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Martin Dominkus
- II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.,II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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40
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Jayasinghe G, Buckle C, Maling LC, To C, Anibueze C, Vinayakam P, Slack R. Medium Term Radiographic and Clinical Outcomes Using a Modular Tapered Hip Revision Implant. Arthroplast Today 2021; 8:181-187. [PMID: 33898674 PMCID: PMC8056170 DOI: 10.1016/j.artd.2021.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/30/2022] Open
Abstract
Background The rate of revision hip arthroplasty surgery is rising. Surgeons must use implants with proven outcomes to help overcome the technical challenges faced during revision surgery. However, outcome studies using these implants are limited. The aim of this study is to investigate the radiographic and clinical outcomes of the Stryker Restoration stem, the most commonly used hip revision stem in the United Kingdom (UK). Methods A retrospective review of a single surgeon case series was performed. Immediate postoperative radiographs were analyzed for offset and leg length discrepancy. Radiographic evidence of subsidence was assessed using follow-up radiographs. Kaplan-Meier survival analysis was applied using explantation and reoperation as endpoints. Patient-reported outcomes were measured using the Oxford Hip Score and EQ-5D-5L. Results One hundred ninety-eight cases were identified. Mean follow-up duration was 51.8 months (range: 24-121). Stem survival during this period was 98%. Reoperation for any reason was 13%. Mean subsidence was 4.18 mm. Analysis of variance testing showed no difference in mean subsidence between revision indications. Mean offset and leg length discrepancies were measured at 4.5 mm and 4.3 mm, respectively. The mean Oxford Hip Score for participants was 27.6. Conclusions This series demonstrates excellent implant survival, with radiographic parameters for reconstruction and subsidence levels comparable to those in the existing literature. The tapered modular hip revision stem provides surgeons with the intraoperative flexibility to overcome some of the anatomical difficulties encountered during revision surgery; this is reflected in the radiographic and clinical outcomes of the cohort in this study.
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Affiliation(s)
- Gihan Jayasinghe
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Chris Buckle
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Lucy Clare Maling
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Christopher To
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Chukwudubem Anibueze
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Parthiban Vinayakam
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
| | - Richard Slack
- Trauma and Orthopaedics Department, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
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Zampelis V, Flivik G. Custom-made 3D-printed cup-cage implants for complex acetabular revisions: evaluation of pre-planned versus achieved positioning and 1-year migration data in 10 patients. Acta Orthop 2021; 92:23-28. [PMID: 32928018 PMCID: PMC7919918 DOI: 10.1080/17453674.2020.1819729] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of custom-made 3D-printed titanium implants for the reconstruction of large acetabular defects has been successively introduced in the last decade. In an observational cohort study we evaluated the agreement between preoperatively planned and actually achieved cup-cage position as well as 1-year follow-up migration of the cup-cage component.Patients and methods - 10 patients with Paprosky III defects underwent revision surgery using a custom-made 3D-printed cup-cage. The position of the implant on postoperative CT scan was compared with the preoperative plan and the postoperative CT scan was compared with the 1-year follow-up CT scan.Results - There was a median deviation in postoperative position versus planned in inclination of 3.6° (IQR 1.0-5.4), in anteversion of -2.8° (IQR -7.5 to 1.2), and in rotation of -1.2° (IQR -3.3 to 0.0). The median deviation in position of the center of rotation (COR) was -0.5 mm (IQR 2.9 to 0.7) in the anteroposterior (AP) plane, -0.6 mm (IQR -1.8 to -0.1) in the mediolateral (ML) plane, and 1.1 mm (IQR -1.6 to 2.8) in the superoinferior (SI) plane. The migration between postoperative and 1-year follow-up caused a mean change in inclination of 0.04° (IQR -0.06 to 0.09), in anteversion of -0.13° (IQR -0.23 to -0.06), and in rotation of 0.05° (IQR -0.46 to 1.4). The migration of COR was -0.08 mm (IQR -0.18 to -0.04) in the AP plane, 0.14 mm (IQR -0.08 to 0.22) in the ML plane, and 0.06 mm (IQR -0.02 to 0.35) in the SI plane. There was no re-revision.Interpretation - The early results show good agreement between planned and achieved cup-cage position and small measured migration values of the cup-cage component at the 1-year follow-up.
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Affiliation(s)
- Vasileios Zampelis
- Department of Orthopedics, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden,Correspondence:
| | - Gunnar Flivik
- Department of Orthopedics, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Chang CY, Wu CT, Numan H, Kuo FC, Wang JW, Lee MS. Survival Analysis of Allografting and Antiprotrusio Cage in Treating Massive Acetabular Bone Defects. J Arthroplasty 2021; 36:682-687. [PMID: 32943318 DOI: 10.1016/j.arth.2020.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Massive acetabular bone defects reconstructed with allografting and antiprotrusio cage in revision hip arthroplasty is less reported in the literature. We here report a series of 84 antiprotrusio cages and analyze the risk factors associated with failure. METHODS All instances of use of an antiprotrusio cage for massive acetabular defect (Paprosky type IIc, III, and pelvic discontinuity) between 2002 and 2017 in the authors' institute were reviewed after institutional review board's approval. Survival analyses based on clinical data, bone defect (Paprosky system), type of allograft, size of cage, fixation quality, and position of cage were performed. Failure was defined as cage loosening or breakage, poor hip function, or cage revision for any reason. RESULTS A total of 84 cages in 77 patients (mean age, 62.9 years), with a mean follow-up period of 6.2 years, had a survival rate of 82.1%. Failure was noted in 15 hips, including mechanical failure in 8 hips, recurrent dislocation in 1 hip, poor hip function in 1 hip, and periprosthetic joint infection in 5 hips. Pelvic discontinuity, reconstruction with morselized allograft alone, and fewer than 4 fixation points to the host bone were associated with higher failure rates (hazard ratios, 4.02, 3.42, and 9.9, respectively). CONCLUSION We found that an antiprotrusio cage combined with strut allografts, fixed securely to the host bone (>4 fixation points), are beneficial for the management of massive acetabular bone defects. However, pelvic discontinuity remains a challenge that warrants the further study of technical or prosthetic innovations, such as triflange implants, cup cage, and 3D-printed implants.
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Affiliation(s)
- Cheh-Yung Chang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Ta Wu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Husam Numan
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Feng-Chi Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. Arch Orthop Trauma Surg 2021; 141:509-516. [PMID: 33354743 PMCID: PMC7900083 DOI: 10.1007/s00402-020-03722-x] [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: 09/18/2020] [Accepted: 12/06/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Restoration cages and bone allografts have been proposed to manage severe acetabular bone defects. We aimed to investigate the migration behaviour of a restoration cup and impacted allograft bone in severe acetabular defects with Einzel-Bild-Röntgen-Analyse (EBRA). METHODS Applying a retrospective study design, 64 cases treated between 2009 and 2016 were reviewed. We determined the preoperative Charlson Comorbidity Index (CCI), pre- to postoperative WOMAC score, blood loss and functional outcome. From preoperative x rays, the acetabular deficiencies were classified according to Paprosky. Cup migration analyses were performed with EBRA. RESULTS Mean age at surgery was 73 (range: 38-93) years. According to the classification by Paprosky et al., 50% (n = 32) of our patients showed a type III B and 28.1% (n = 18) a type III A defect. Radiological follow-up for migration analysis was 35 (range: 4-95) months. Migration analysis showed a mean cup migration of 0.7 mm (range: 5.7-9.6) medial and 1.8 mm (range: 1.7-12.6) cranial. CONCLUSION In conclusion, acetabular restoration cages in combination with bone impaction grafting showed a low revision rate at a mean follow-up of 35 months. Mean cup migration revealed low rates after 2 years and suggested a stable postoperative implant position.
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Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res 2020; 38:2640-2648. [PMID: 32427351 DOI: 10.1002/jor.24752] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
We report on the accuracy, measured with three-dimensional (3D) computed tomography (CT) postoperatively, in positioning custom 3D printed titanium components in patients with large acetabular defects. Twenty patients (13 females and 7 males) received custom-made acetabular implants between 2016 and 2018; the mean age was 66 years (SD = 11.6) and their mean body mass index was 28 (SD = 6.1). The median time to follow up was 25.5 months, range: 12 to 40 months. We describe a comparison method that uses the 3D models of CT-generated preoperative plans and the postoperative CT scans to quantify the discrepancy between planned and achieved component positions. Our primary outcome measures were the 3D-CT-measured difference between planned and achieved a component position in six degrees of freedom: center of rotation (CoR), component rotation, inclination (INC), and version (VER) of the cup. Our secondary outcome measures were: Oxford hip score, walking status, and complication rate. All components (100%) were positioned within 10 mm of planned CoR (in the three planes). Eighteen (95%) components were not rotated by more than 10° compared to the plan. Eleven (58%) components were positioned within 5° of planned cup angle (INC and VER). To date one complication has occurred, a periprosthetic fracture. This is the largest study in which postoperative 3D-CT measurements and clinical outcomes of custom-made acetabular components have been assessed. Accurate pre-op planning and the adoption of custom 3D printed implants show promising results in complex hip revision surgery.
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Affiliation(s)
- Matthieu Durand-Hill
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | | | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London.,Royal National Orthopaedic Hospital, Stanmore, UK
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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: 0.2] [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.
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Gu A, Adriani M, Malahias MA, Fassihi SC, Nocon AA, Bostrom MP, Sculco PK. Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review. HSS J 2020; 16:288-295. [PMID: 33088242 PMCID: PMC7534882 DOI: 10.1007/s11420-020-09766-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A variety of classification systems have been developed to help surgeons treat patients with acetabular or femoral bone loss in total hip arthroplasty, yet no "gold standard" for classification has been agreed upon. Furthermore, the reliability and validity of the available classification systems remain unknown. QUESTIONS/PURPOSE The aims of our study were to determine the reliability and validity of the three most common acetabular and femoral bone loss classification systems (Paprosky, American Academy of Orthopaedic Surgeons [AAOS], and Saleh and Gross). METHODS A systematic review of the literature was performed to identify studies that reported on the reliability or validity (or both) of the acetabular and femoral components of the three bone loss classification systems. RESULTS In all, seven articles met our inclusion criteria. Six studies reported on the reliability (all six studies) or validity (three studies) of acetabular bone loss rating systems (286 acetabula), and five analyzed reliability (all five studies) or validity (three studies) of femoral bone loss classification systems (364 femurs). In studies in which either the Paprosky or AAOS acetabular bone loss classifications were used, the classification systems were considered unreliable in 75% and 100% of them, respectively. On the femoral side, the Paprosky classification demonstrated moderate interobserver and good intraobserver reliability. The AAOS femoral bone classification was found to have good intraobserver reliability but poor interobserver reliability. The Saleh and Gross acetabular and femoral bone loss classification systems yielded mixed results, but each was considered reliable in one of the studies looking at these aspects of the systems. CONCLUSION Although surgical techniques, treatment options, and advanced imaging available to the surgeon have evolved over the past few decades, the acetabular and femoral bone loss classification systems, first developed in the 1990s, have remained largely unchanged. Our results indicate that improvements to these systems are necessary in order for them to be as useful as possible in planning the surgical course.
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Affiliation(s)
- Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Marco Adriani
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Safa C. Fassihi
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Allina A. Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Mathias P. Bostrom
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
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Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Print Med 2020; 6:23. [PMID: 32845428 PMCID: PMC7450581 DOI: 10.1186/s41205-020-00074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D Printed custom-made implants constitute a viable option in patients with acetabular Paprosky III defects. In these patients, needing complex hip revision surgery, the appreciation of the bony defect is crucial to assure stable fixation of the customised implant, often intended to replace a failed one. We aimed to understand the effect of metal artefact on the design of customised implants. METHODS 26 patients with massive acetabular defects were referred, between May 2016 and September 2018, to our institution classified as "un-reconstructable" by other hospitals. They all received custom 3D-printed acetabular cups. A subset of them underwent two-stage revision surgery due to infection. We then extended the two-stage procedure to the cases where metal artefacts were significantly affecting the reading of the CT scans. CT scans of patients' pelvises were taken pre and post-implant removal. We assessed for changes in bony shape and volume of the pelvis using 3D imaging software and quantified the effect on implant design with CAD software. RESULTS Eight (out of 26) patients (31%) underwent two-stage revision surgery. The CT bony reconstructions between the two timepoints changed in all cases. The changes were mostly associated to the shape and distribution of the acetabular defects. Three of these cases (37.5%) showed a remarkable difference in the remaining bone that led to a change in implant design. So far, there has been no difference in the clinical outcome between the patients who underwent single (n = 18) and two-stage surgery (n = 8). CONCLUSIONS The shape of the acetabulum reconstructed from CT data is potentially altered by metal artefact and bone excised during removal of the failed component. For "end-of-road" acetabular reconstruction, we recommend surgeons consider the use of two-stage surgery to enable a reliable fitting of the complex shape of 3D-printed implants.
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Affiliation(s)
- Anna Di Laura
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
| | - Robert Wescott
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Alister J. Hart
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
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Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155624. [PMID: 32759871 PMCID: PMC7432051 DOI: 10.3390/ijerph17155624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 01/13/2023]
Abstract
Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.
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Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep 2020; 13:13/5/e233965. [PMID: 32457031 PMCID: PMC7253004 DOI: 10.1136/bcr-2019-233965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aseptic loosening is the most common cause for total hip arthroplasty revision. Acetabular cup revision is a significant challenge in the presence of a large bone defect. One of the options for cup revision in the presence of a large bone defect is the recently introduced customised three-dimensional (3D)-printed reconstruction. We present the case of a 68-year-old woman successfully treated with a customised revision acetabular implant for the failure of triflange cup in the presence of large acetabular defect. The modern orthopaedic surgeon must have full knowledge of customised 3D-printed reconstruction to have as a reserve solution for difficult hip revision surgery.
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Affiliation(s)
- Stefano Zanasi
- Hesperia Hospital, Modena, Emilia-Romagna, Italy.,University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Hassan Zmerly
- San Pier Damiano Hospital, Faenza, RA, Italy .,UCM (MT), LUDES, Lugano, Switzerland
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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: 2] [Impact Index Per Article: 0.4] [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.
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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
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