Do custom 3D-printed revision acetabular implants provide enough value to justify the additional costs? The health-economic comparison of a new porous 3D-printed hip implant for revision arthroplasty of Paprosky type 3B acetabular defects and its closest alternative

Introduction: The treatment of extensive bone loss and massive acetabular defects can be compounded by several challenges and pitfalls. The survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The goal of the present study was to analyse the outcomes of 3D-printed patient-specific acetabular components in the management of extensive acetabular defects and combined pelvic discontinuity (PD). Methods: 9 patients underwent revision THA using 3D-printed custom acetabular components to reconstruct extensive acetabular defects. The Paprosky classifications were determined in all patients. The primary outcome measure was the implant-associated failure rate. Results: 1 out of 9 patients suffered an implant-associated complication (11%). The overall implant-associated survival rate was 89%. The overall complication rate was 56%. Conclusions: The patient-specific acetabular component technique shows promise for the treatment of patients with severe acetabular defects in revision THA. Further research aimed at reducing costs and improving the complication rate are warranted.

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Health-economic comparison of continuous subcutaneous insulin infusion with multiple daily injection for the treatment of Type 1 diabetes in the UK: Response to Roze et al.

Diabetic Medicine ◽

10.1111/j.1464-5491.2006.01853.x ◽

2006 ◽

Vol 23 (6) ◽

pp. 709-709 ◽

Cited By ~ 1

Author(s):

J. H. DeVries

Keyword(s):

Health Economic ◽

Type 1 Diabetes ◽

Continuous Subcutaneous Insulin Infusion ◽

Insulin Infusion ◽

Daily Injection ◽

Subcutaneous Insulin ◽

Multiple Daily Injection ◽

The Uk ◽

Economic Comparison

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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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Reconstruction of Paprosky type III Acetabular Defects by the Three-dimensional Printed Porous Augment: Techniques and Clinical Outcomes of 18 Consecutive Cases

10.21203/rs.3.rs-94006/v1 ◽

2020 ◽

Author(s):

Jun Fu ◽

Ming Ni ◽

Xiang Li ◽

Wei Chai ◽

Libo Hao ◽

...

Keyword(s):

Clinical Outcomes ◽

Bone Defect ◽

Three Dimensional ◽

Acetabular Bone ◽

Type Iii ◽

Acetabular Bone Defect ◽

3D Printed ◽

The Mean ◽

Acetabular Defects

Abstract Background and Purpose: A major challenge posed by primary and revision total hip arthroplasty (THA) is the management of severe acetabular bone defect. Previous surgical techniques have certain limitations in the anatomical reconstruction and accurate match of severe acetabular defects. Until now, reports are scanty on the clinical outcomes of acetabular reconstruction by the three-dimensional (3D) printed porous augments in bone defect patients. This study reported the clinical outcomes of reconstruction of Paprosky type III acetabular defects by 3D printed porous augments.Methods: 18 patients with Paprosky type III acetabular defects receiving reconstructive surgery by 3D printed porous augments were included in current study. Their data, including general information, intra-operative findings, imaging results, functional scores and complications were retrospectively analyzed.Results: The mean follow-up time lasted 33.3 ± 2.0 (24-56) months. The average limb-length discrepancy (LLD) was 31.7 ± 4.2 (3-59) mm preoperatively, 7.7 ± 1.4 (1-21) mm postoperatively (p<0.0001) and 7.5 ± 1.2 (0-18) mm at the latest follow-up. The mean vertical position of hip center of rotation (HCOR) from the inter teardrop line changed from preoperative 50.7 ± 3.9 (23.3-75.3) mm to postoperative 22.9 ± 1.9 (10.1-40.3) mm (p<0.0001), with the latest follow-up revealing an HCOR of 22.3 ± 1.7 (11.0-40.5) mm. Follow-up study showed that no hip had radiolucencies and radiological loosening of the acetabular components and augment. The average HHS improved from 40.3 ± 4.5 (10.5-71) before operation to 88.4 ± 1.9 (75-97) at the last follow-up (p<0.0001). Moreover, follow-up exhibited that no periprosthetic joint infection, hip dislocation, fracture and re-revision occurred. Conclusion: Surgical treatment of Paprosky type III acetabular defect with 3D printed porous augment was simple, achieved good match between porous augment and the defect bone surface and the acetabular component, ideally restored LLD and HCOR after operation, significantly improved HHS score and attained good early clinical outcomes. It is a promising personalized solution for patients with severe acetabular bone defect.

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