Biomechanical restoration of metastatic cancer-induced peri-acetabular bone defects by ablation-osteoplasty-reinforcement-internal fixation technique: To screw or not to screw?

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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Reconstruction of Acetabular Bone Defects in Primary Total Hip Replacement Using Bone Graft

Mastering Orthopedic Techniques Total Hip Arthroplasty ◽

10.5005/jp/books/11713_27 ◽

2012 ◽

pp. 409-409

Author(s):

Henry Jones ◽

Nikhil Shah ◽

Anthony Clayson ◽

Peter Kay

Keyword(s):

Bone Graft ◽

Total Hip Replacement ◽

Hip Replacement ◽

Bone Defects ◽

Acetabular Bone ◽

Total Hip ◽

Acetabular Bone Defects

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Theoretical Aspects, Modern Treatment Options and Practical Case Presentations in Hip and Knee Tumoral and Revision Bone Defect Reconstruction Surgery

Revista de Chimie ◽

10.37358/rc.18.12.6815 ◽

2019 ◽

Vol 69 (12) ◽

pp. 3664-3668

Author(s):

George Dinache ◽

Marinel Drignei ◽

Stergios Ganatsios ◽

Eric Jovenet ◽

Radu Costea ◽

...

Keyword(s):

Bone Defect ◽

Revision Surgery ◽

Distal Femur ◽

Treatment Options ◽

Bone Defects ◽

Practical Case ◽

Acetabular Bone ◽

Acetabular Bone Defects ◽

Case Presentations ◽

Bone Defect Reconstruction

Bone defects are a challenge to any and in fact every orthopedic surgeon, be they as a consequence of trauma, peri-implant bone loss as is the case in revision surgery or, more often than not, in tumors of the bone. These defects are in most cases difficult to reconstruct, but even more so in the case when they are located around the major joints of the lower limb, i.e. the hip and the knee. We focus in this article on acetabular bone defects as well as on defects around the knee (distal femur and proximal tibia). We present implant possibilities and modern means of reconstructing the bone defect using augments. We also present three representative cases from our Clinic, to further exemplify the discussed concepts. We present our opinions on reconstructing bone defects after tumor and revision surgery in the hip and knee and we draw conclusions.

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Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

Hip International ◽

10.1177/1120700018813208 ◽

2018 ◽

Vol 28 (2_suppl) ◽

pp. 66-72 ◽

Cited By ~ 4

Author(s):

Mattia Loppini ◽

Paolo Schiavi ◽

Antonello Della Rocca ◽

Francesco Traverso ◽

Federico Della Rocca ◽

...

Keyword(s):

Bone Defects ◽

Acetabular Reconstruction ◽

Trabecular Metal ◽

Acetabular Bone ◽

Pelvic Discontinuity ◽

Type Iii ◽

Heterotopic Ossifications ◽

Radiographic Outcomes ◽

Acetabular Bone Defects

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

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Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

Revista de Chimie ◽

10.37358/rc.18.8.6503 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2217-2221

Author(s):

Stefan Mogos ◽

George Viscopoleanu ◽

Monica Dascalu ◽

Radu Orfanu

Keyword(s):

Revision Arthroplasty ◽

Bone Defects ◽

Harris Hip Score ◽

Management Options ◽

Acetabular Bone ◽

Type Iiia ◽

Acetabular Bone Defects ◽

The Mean ◽

Acetabular Defects

The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.

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