Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review

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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Impaction bone grafting in hip re-revision surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1228.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 492-499

Author(s):

Eduardo Garcia-Rey ◽

Laura Saldaña ◽

Eduardo Garcia-Cimbrelo

Keyword(s):

Aseptic Loosening ◽

Acetabular Component ◽

Revision Surgery ◽

Bone Grafting ◽

Bone Defects ◽

Bone Stock ◽

Impaction Bone Grafting ◽

Acetabular Bone ◽

Acetabular Bone Defects

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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Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss

Acta Orthopaedica ◽

10.3109/17453674.2012.718518 ◽

2012 ◽

Vol 83 (4) ◽

pp. 347-352 ◽

Cited By ~ 50

Author(s):

W Steven Borland ◽

Raj Bhattacharya ◽

James P Holland ◽

Nigel T Brewster

Keyword(s):

Bone Loss ◽

Bone Grafting ◽

Trabecular Metal ◽

Impaction Bone Grafting ◽

Acetabular Bone ◽

Acetabular Bone Loss

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Biological Repair of Acetabular Bone Defects and Cup Migration After Impaction Bone Grafting in Total Hip Arthroplasty

Acetabular Revision Surgery in Major Bone Defects ◽

10.1007/978-3-319-98596-1_6 ◽

2018 ◽

pp. 103-113

Author(s):

Eduardo García-Rey ◽

Eduardo García-Cimbrelo

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Grafting ◽

Bone Defects ◽

Impaction Bone Grafting ◽

Acetabular Bone ◽

Total Hip ◽

Biological Repair ◽

Acetabular Bone Defects

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Acetabular Reconstruction with the Burch-Schneider Antiprotrusio Cage and Bulk Allografts: Minimum 10-Year Follow-Up Results

BioMed Research International ◽

10.1155/2014/194076 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

Dario Regis ◽

Andrea Sandri ◽

Ingrid Bonetti

Keyword(s):

Bone Loss ◽

Survival Rates ◽

Harris Hip Score ◽

Pelvic Bone ◽

Acetabular Reconstruction ◽

Acetabular Bone ◽

Acetabular Bone Loss ◽

Additional Surgery ◽

Acetabular Bone Defects

Reconstruction of severe pelvic bone loss is a challenging problem in hip revision surgery. Between January 1992 and December 2000, 97 hips with periprosthetic osteolysis underwent acetabular revision using bulk allografts and the Burch-Schneider antiprotrusio cage (APC). Twenty-nine patients (32 implants) died for unrelated causes without additional surgery. Sixty-five hips were available for clinical and radiographic assessment at an average follow-up of 14.6 years (range, 10.0 to 18.9 years). There were 16 male and 49 female patients, aged from 29 to 83 (median, 60 years), with Paprosky IIIA (27 cases) and IIIB (38 cases) acetabular bone defects. Nine cages required rerevision because of infection (3), aseptic loosening (5), and flange breakage (1). The average Harris hip score improved from 33.1 points preoperatively to 75.6 points at follow-up (P<0.001). Radiographically, graft incorporation and cage stability were detected in 48 and 52 hips, respectively. The cumulative survival rates at 18.9 years with removal for any reason or X-ray migration of the cage and aseptic or radiographic loosening as the end points were 80.0% and 84.6%, respectively. The use of the Burch-Schneider APC and massive allografts is an effective technique for the reconstructive treatment of extensive acetabular bone loss with long-lasting survival.

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Induced Membrane Bone Grafting Technique for Treatment of Large Postinfectious Acetabular Bone Defects

Arthroplasty Today ◽

10.1016/j.artd.2020.04.011 ◽

2020 ◽

Vol 6 (3) ◽

pp. 322-329

Author(s):

Gerald Joseph Zeng ◽

Wei Sheng Foong ◽

Sheng Xu ◽

Hee Nee Pang

Keyword(s):

Bone Grafting ◽

Bone Defects ◽

Acetabular Bone ◽

Induced Membrane ◽

Membrane Bone ◽

Grafting Technique ◽

Acetabular Bone Defects

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Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty

Orthopedic Reviews ◽

10.4081/or.2020.8655 ◽

2020 ◽

Author(s):

Fabio Mancino ◽

Giorgio Cacciola ◽

Davide De Marco ◽

Alexander Greenberg ◽

Carlo Perisano ◽

...

Keyword(s):

Bone Loss ◽

Hip Arthroplasty ◽

Bone Defects ◽

Acetabular Reconstruction ◽

Metal Mesh ◽

Acetabular Bone ◽

Acetabular Bone Loss ◽

Custom Made ◽

Long Term Studies

Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large “jumbo cups”, oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.

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Mid-term result of acetabular reconstruction using a Kerboull-type acetabular reinforcement device with hydroxyapatite impaction

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720971838 ◽

2020 ◽

pp. 221049172097183

Author(s):

Hidetatsu Tanaka ◽

Daisuke Chiba ◽

Norikazu Yamada ◽

Masahiko Tanaka ◽

Yoshiyuki Kuwahara ◽

...

Keyword(s):

Survival Rates ◽

Acetabular Reconstruction ◽

Type Ii ◽

Term Result ◽

Acetabular Bone ◽

Kaplan Meier ◽

Acetabular Bone Defects ◽

The Mean ◽

Mid Term Results ◽

Reinforcement Device

The aim of this study is to investigate the mid-term results of 29 hips in 26 patients who underwent acetabular reconstruction using a Kerboull-type acetabular reinforcement device and impaction with hydroxyapatite (HA) granules. The acetabular bone defects were AAOS type II for six hips and type III for 23 hips. The mean Merle d’Aubigné clinical scores were significantly improved after operation. Six hips developed implant migration and breakage, and five of six hips were revised after an average of 5.5 (range 2.0–8.8) years. All hips with thickness of the grafted HA less than 10 mm were stable. As the HA became thicker, the failure rate were significantly increased. The Kaplan–Meier survival rates at 10 years were 73.2%, with 100% and 67.0% for AAOS type II and III defect respectively as the end point was failure condition. Reconstruction using a Kerboull-type acetabular reinforcement device and impaction with HA granules was an alternative method in the absence of adequate allografts.

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