Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

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Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

Advances in Orthopedics ◽

10.1155/2013/347358 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Mitsuyoshi Yamamura ◽

Nobuo Nakamura ◽

Hidenobu Miki ◽

Takashi Nishii ◽

Nobuhiko Sugano

Keyword(s):

Total Hip Arthroplasty ◽

Bone Cement ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Full Weight Bearing ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Revision Tha ◽

Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

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Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

10.21203/rs.2.17840/v2 ◽

2019 ◽

Author(s):

Hao Tang ◽

Yixin Zhou ◽

Zhuyi Ma ◽

Yong Huang ◽

Shengjie Guo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Porous Metal ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Fixation Group ◽

Acetabular Defects ◽

Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

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Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

Hip International ◽

10.1177/1120700020917125 ◽

2020 ◽

Vol 30 (1_suppl) ◽

pp. 7-11

Author(s):

Massimo Franceschini ◽

N Amir Sandiford ◽

Vincenzo Cerbone ◽

Lucio Cappelli Toledo de Araujo ◽

Daniel Kendoff

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Short Term ◽

Total Hip ◽

Antibacterial Coating ◽

Revision Tha ◽

Detailed Function ◽

New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

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Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499018783913 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878391 ◽

Cited By ~ 3

Author(s):

Jun-Dong Chang ◽

In-Sung Kim ◽

Sameer Ajit Mansukhani ◽

Vishwas Sharma ◽

Sang-Soo Lee ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Fourth Generation ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Acetabular Cup ◽

Total Hip ◽

Revision Tha ◽

Ceramic On Ceramic

Purpose: The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. Methods: A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0–9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. Results: At the final follow-up examination, the average HHS was 90.4 (range, 67–100). The average WOMAC pain and physical function score were 2.8 (range, 0–12) and 16.4 (range, 0–42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. Conclusion: Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.

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Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

10.21203/rs.2.17840/v1 ◽

2019 ◽

Author(s):

Hao Tang ◽

Yixin Zhou ◽

Zhuyi Ma ◽

Yong Huang ◽

Shengjie Guo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Porous Metal ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Fixation Group ◽

Acetabular Defects ◽

Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

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Long-term outcomes of Wagner self-locking stem with bone allograft for Paprosky type II and III bone defects in revision total hip arthroplasty: A mean 15.7-year follow-up

Journal of Orthopaedic Surgery ◽

10.1177/2309499019854156 ◽

2019 ◽

Vol 27 (2) ◽

pp. 230949901985415 ◽

Cited By ~ 2

Author(s):

Junting Zang ◽

Katsufumi Uchiyama ◽

Mitsutoshi Moriya ◽

Kensuke Fukushima ◽

Naonobu Takahira ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Allograft ◽

Bone Defects ◽

Type Ii ◽

Revision Total Hip Arthroplasty ◽

Long Term Outcomes ◽

Total Hip

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Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1472.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 725-732 ◽

Cited By ~ 4

Author(s):

E. Gibon ◽

N. Barut ◽

J-P. Courpied ◽

M. Hamadouche

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Inferior Margin ◽

Total Hip ◽

Type Iii ◽

Revision Tha ◽

Reinforcement Device

Aims The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d’Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725–32.

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