Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow Up

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p<0.05) and its uncontained defects (p<0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p<0.05) and in the early stages of observation (p<0.05).Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

Download Full-text

Cup-cage construct for massive acetabular defect in revision hip arthroplasty- A case series with medium to long-term follow-up

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.04.021 ◽

2020 ◽

Vol 11 (1) ◽

pp. 62-66 ◽

Cited By ~ 1

Author(s):

Dan Arvinte ◽

Manish Kiran ◽

Manoj Sood

Keyword(s):

Hip Arthroplasty ◽

Case Series ◽

Revision Hip Arthroplasty ◽

Acetabular Defect ◽

Long Term Follow Up

Download Full-text

Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-015-1703-5 ◽

2015 ◽

Vol 25 (8) ◽

pp. 1279-1284 ◽

Cited By ~ 3

Author(s):

Gowthaman Arumugam ◽

Shashi Kumar Nanjayan ◽

Conal Quah ◽

Philip Wraighte ◽

Peter Howard

Keyword(s):

Cancellous Bone ◽

Hip Arthroplasty ◽

Revision Hip Arthroplasty ◽

Follow Up Study ◽

Long Term Follow Up

Download Full-text

Monobloc implants in cementless total hip arthroplasty in patients with Legg-Calve-Perthes disease: a long-term follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1748-1 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Ze-Yu Luo ◽

Hao-Yang Wang ◽

Duan Wang ◽

Hui Pan ◽

Fu-Xing Pei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Perthes Disease ◽

Total Hip ◽

Cementless Total Hip Arthroplasty ◽

Long Term Follow Up

Download Full-text

Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up

The Bone & Joint Journal ◽

10.1302/0301-620x.101b3.bjj-2018-0959.r1 ◽

2019 ◽

Vol 101-B (3) ◽

pp. 311-316 ◽

Cited By ~ 6

Author(s):

J. Löchel ◽

V. Janz ◽

C. Hipfl ◽

C. Perka ◽

G. I. Wassilew

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Screw Fixation ◽

Acetabular Revision ◽

Revision Total Hip Arthroplasty ◽

Pelvic Discontinuity ◽

Acetabular Defects

Aims The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique. Patients and Methods Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity. Results The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001). Conclusion The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316.

Download Full-text

A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design

Joints ◽

10.1055/s-0040-1710388 ◽

2020 ◽

Author(s):

Christian Carulli ◽

Giacomo Sani ◽

Fabrizio Matassi ◽

Roberto Civinini ◽

Massimo Innocenti

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Systemic Complications ◽

Total Hip ◽

Metal On Metal ◽

Long Term Follow Up

Abstract Purrpose Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution. Methods Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t-test. Results The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups. Conclusion Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up. Level of Evidence This is a therapeutic case series, Level 4 study.

Download Full-text

Pseudotumours, cobalt and clinical outcome in small head metal-on-metal versus conventional metal-on-polyethylene total hip arthroplasty

Hip International ◽

10.1177/1120700019832877 ◽

2019 ◽

Vol 30 (1) ◽

pp. 56-63

Author(s):

Hugo C van der Veen ◽

Inge HF Reininga ◽

Wierd P Zijlstra ◽

Martijn F Boomsma ◽

Sjoerd K Bulstra ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Follow Up Study ◽

Metal On Metal ◽

Small Head ◽

Long Term Follow Up ◽

Serum Cobalt

Background: Metal-on-metal total hip arthroplasty (MoM THA) is associated with the formation of pseudotumours. Studies mainly concern pseudotumour formation in large head MoM THA. We performed a long-term follow-up study, comparing pseudotumour incidence in small head metal-on-metal (SHMoM) THA with conventional metal-on-polyethylene (MoP) THA. Predisposing factors to pseudotumour formation were assessed. Methods: From a previous randomised controlled trial comparing SHMoM (28 mm) cemented THA with conventional MoP cemented THA, patients were screened using a standardised CT protocol for the presence of pseudotumours. Serum cobalt levels and functional outcome were assessed. Results: 56 patients (33 MoP and 23 MoM) were recruited after mean follow-up of 13.4 years (SD 0.5). The incidence of pseudotumours was 1 (5%) in the SHMoM THA cohort and 3 (9%) in the MoP THA cohort. Prosthesis survival was 96% for both SHMoM and MoP THAs. Serum cobalt levels did not exceed acceptable clinical values (<5 µg/L) whereas no differences in cobalt levels were detected at follow-up between both groups. Oxford and Harris Hip Scores were good and did not differ between SHMoM and MoP THA. Conclusions: This long-term follow-up study shows a low incidence of pseudotumour formation and good functional outcome in cemented head-taper matched SHMoM and MoP THA.

Download Full-text