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

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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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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Bone defect map of the true acetabulum in hip dysplasia (Crowe type II and III) based on three-dimensional image reconstruction analysis

Scientific Reports ◽

10.1038/s41598-021-02448-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xinggui Wen ◽

Jianlin Zuo ◽

Tong Liu ◽

Zhongli Gao ◽

Jianlin Xiao

Keyword(s):

Bone Defect ◽

Three Dimensional ◽

Bone Defects ◽

Acetabular Reconstruction ◽

Type Ii ◽

Acetabular Bone ◽

Depth Study ◽

Acetabular Bone Defects ◽

Ct Data ◽

Bone Coverage

AbstractThe high hip center technique (HHC) is considered to be feasible for acetabular reconstruction in patients with DDH, but there is little in-depth study of its specific impact on Crowe type II and III DDH. The purpose of this study was to simultaneously analyze the effect of HHC on bone coverage of the cup (CC) in the acetabular reconstruction of type II and III DDH patients and to propose a map of acetabular bone defects from the perspective of the cup. Forty-nine hip CT data of 39 patients with DDH (Crowe type II and III) were collected to simulate acetabular reconstruction by cup models of different sizes (diameter 38mm–50 mm, 2 mm increment) with the HHC technique. The frequency distribution was plotted by overlapping the portions of the 44 mm cups that were not covered by the host bone. The mean CC of cups with sizes of 38 mm, 40 mm, 42 mm, 44 mm, 46 mm, 48 mm, and 50 mm at the true acetabula were 77.85%, 76.71%, 75.73%, 74.56%, 73.68%, 72.51%, and 71.75%, respectively, and the maximum CC increments were 21.24%, 21.58%, 20.86%, 20.04%, 18.62%, 17.18%, and 15.42% (P < 0.001), respectively, after the cups were elevated from the true acetabula. The bone defect map shows that 95% of type II and III DDH acetabula had posterosuperior bone defects, and approximately 60% were located outside the force line of the hip joint. Acetabular cups can meet a CC of more than 70% at the true acetabulum, and approximately 60% of Crowe type II and III DDH patients can obtain satisfactory CC at the true acetabulum by using a 44-mm cup without additional operations.

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Symptomatic osteonecrosis of the hip and knee in patients with systemic lupus erythematosus: Prevalence, pattern, and comparison of natural course

Lupus ◽

10.1177/09612033211031007 ◽

2021 ◽

pp. 096120332110310

Author(s):

Mehmet Ersin ◽

Mehmet Demirel ◽

Mehmet Ekinci ◽

Lezgin Mert ◽

Çiğdem Çetin ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Bone Structure ◽

Survival Rates ◽

Knee Joints ◽

Joint Involvement ◽

Systemic Lupus ◽

Kaplan Meier ◽

The Mean

Objective Osteonecrosis (ON), also known as avascular necrosis, is characterized by the collapse of the architectural bone structure secondary to the death of the bone marrow and trabecular bone. Osteonecrosis may accompany many conditions, especially rheumatic diseases. Among rheumatic diseases, osteonecrosis is most commonly associated with systemic lupus erythematosus (SLE). We assessed prevalence and distribution pattern of symptomatic ON in patients with SLE and compare the natural courses of hip and knee ON. Methods 912 SLE patients admitted between 1981 and 2012 were reviewed. SLE patients with symptomatic ON were retrospectively identified both from the existing SLE/APS database. The prevalence of symptomatic ON was calculated; with ON, the joint involvement pattern was determined by examining the distribution of the joints involved, and then the data about the hip and knee joints were entered in the Kaplan-Meier analysis. Kaplan-Meier methods were used to calculate 5- and 10-year rates of ON-related hip (the hip group) and knee survival (the knee group). Results Symptomatic ON developed in various joints in 97 of 912 patients with SLE, and the overall prevalence of ON was detected as 10.6%. The mean age at the time of SLE and ON diagnoses were 27.9 ± 9.9 (14–53) and 34.2 ± 11.3 (16–62) years, respectively. The mean duration from diagnosis of SLE to the first development of ON was 70.7± 60.2 (range = 0–216) months. The most common site for symptomatic ON was the hips (68%, n=66), followed by the knees (38%, n = 37). According to Kaplan-Meier analysis, hip and knee joint survival rates associated with 5-year ON were 51% and 88%, and 10-year survival rates were 43% and 84%, respectively. Conclusion We observed that the prevalence of symptomatic ON in patients with SLE was 10.6%. With the estimated 10-year survival rates of 40% versus 84% for the hip and knee joints, respectively, hip involvement may demonstrate a more aggressive course to end-stage osteoarthritis than the knee involvement.

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Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency

Hip International ◽

10.1177/1120700018757788 ◽

2018 ◽

Vol 28 (5) ◽

pp. 491-497 ◽

Cited By ~ 7

Author(s):

Vahit E Ozden ◽

Goksel Dikmen ◽

Burak Beksac ◽

Remzi Tozun

Keyword(s):

Acetabular Reconstruction ◽

Dual Mobility Cup ◽

Survivorship Analysis ◽

Dual Mobility ◽

Total Hip ◽

Kaplan Meier ◽

Dual Mobility Cups ◽

The Mean ◽

Cemented Cup

Introduction: The purpose of this study was to summarise the performance of dual-mobility cup systems for revision total hip arthroplasty in patients with abductor-trochanteric complex deficiency. Methods: We prospectively followed 17 patients (20 hips) with a mean age of 64.5 years (range 33-89 years) who underwent acetabular reconstruction with dual-mobility cups for aseptic loosening in 12 hips, infection treatment as second or single stage in 6 hips, and instability in 2 hips. All of the patients had abductor insufficiency. We evaluated the clinical Harris Hip scores (HHS) and radiographs for migration, loosening, and osteolysis. The survival of the components was calculated according to Kaplan-Meier survivorship analysis, and failure was defined as any dislocation, acetabular component or total hip revision for any reason. Results: The mean duration of follow-up was 38.1 months (range 24-98 months). There were 2 (12.5%) revisions for cemented cup migration after 11 months and 19 months respectively. There were no dislocations. At the last follow-up, the mean HHS increased from 42 points preoperatively to 86 points. The cumulative survival rate of the dual-mobility cup system was 93% (95% confidence interval 88-98.7%) at 5 years, with any revision as the end point. Conclusion: Dual-mobility cups may provide excellent stability in patients with abductor-trochanteric complex insufficiency.

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The Best Bone of Acetabulum for Cup Component Placement in Total Hip Arthroplasty in Patients with Crowe Type I-III Dysplastic Hips: a Computer Simulation Study

10.29007/nz6g ◽

2019 ◽

Author(s):

Linli Zheng ◽

Yangyang Lin ◽

Xiaoyan Zhang ◽

Qianhui Ling ◽

Weiming Liao ◽

...

Keyword(s):

Computer Software ◽

Group Differences ◽

Acetabular Reconstruction ◽

Type I ◽

Type Ii ◽

Bone Stock ◽

Acetabular Bone ◽

Type Iii ◽

Acetabular Bone Stock ◽

Stock Values

For cup implantation in dysplastic acetabulum, the vertical height of the cup center (V-HCC) should be carefully and precisely controlled in order to achieve sufficient host bone-cup coverage (BCC), but excessively superior placement of the cup should be avoided. Using computer software, pelvis models were separately reconstructed in 51 patients (61 hips) with severe osteoarthritis secondary to Crowe type I-III hips. Acetabular height and doom thickness were measured on the mid-acetabular coronal cross section. V-HCC was defined as the vertical distance from the cup center to the interteardrop line (ITL). In the cup implantation simulation, the cup was placed at the initial preset position, with a V-HCC of 15 mm, and moved proximally by 3-mm increments. At each level, the BCC was automatically calculated by computer. There were no significant between-group differences in maximum thickness of the acetabular doom; however peak bone stock values were obtained at heights of 41.63 mm ± 5.14 mm (Crowe type I), 47.58 mm ± 4.10 mm (Crowe type II), and 55.78 mm ± 3.64 mm (Crowe type III) above the ITL. At 15 mm of HCC, BCC was 79%±7% (Crowe type I), 74%±9% (Crowe type II), and 61%±6% (Crowe type III). In order to achieve 80% of the BCC, the evaluation distance was 1.33 ± 1.62 mm (95% CI 0.67–2.01), 3.32 ± 2.94 mm (95% CI 1.94–4.69), and 9.68 ± 3.91 mm (95% CI 7.60–11.77) for Crowe type I, II, and III hips, respectively. Acetabular bone stock for cup placement correlates with the degree of hip dysplasia in patients. During acetabular reconstruction in Crowe type I, II, or III hips, slightly superior placements, <25 mm from the ITL, retained sufficient bone coverage.

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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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Mid-term results of acetabular reconstruction using a Kerboull-type acetabular reinforcement device

International Orthopaedics ◽

10.1007/s00264-011-1248-0 ◽

2011 ◽

Vol 36 (1) ◽

pp. 23-26 ◽

Cited By ~ 19

Author(s):

Junji Hori ◽

Yuji Yasunaga ◽

Takuma Yamasaki ◽

Tomokazu Yoshida ◽

Seigo Oshima ◽

...

Keyword(s):

Acetabular Reconstruction ◽

Mid Term Results ◽

Reinforcement Device

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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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Biomechanical Analysis of a Novel Acetabulum Reconstruction Technique with Acetabulum Reconstruction Cage and Threaded Rods after Type II Pelvic Resections

Sarcoma ◽

10.1155/2016/8627023 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Vivek Ajit Singh ◽

Hassan Elbahri ◽

Rukmanikanthan Shanmugam

Keyword(s):

Hip Replacement ◽

Biomechanical Analysis ◽

Acetabular Reconstruction ◽

Reconstruction Technique ◽

Type Ii ◽

Acetabular Cup ◽

Viable Option ◽

Load To Failure ◽

The Mean ◽

Biomechanical Strength

Background. Periacetabular resections with reconstruction has high rates of complications due to the complexity of the reconstruction. We have improvised a novel technique of reconstruction for type II and type II + III pelvic resections with the use of a commercially available acetabulum reconstruction cage (gap II, Stryker) and threaded rods.Objectives. The aim of our study is to determine the biomechanical strength of our reconstruction compared to the traditional cemented total hip replacement (THR) designs in normal acetabulum and establish its mode of failure.Methods. Five sets of hemipelvises were biomechanically tested (Instron® 3848, MA, USA). These constructs were subjected to cyclic loading and load to failure.Results. The reconstructed acetabulum was stiffer and required a higher load to failure compared to the intact pelvis with a standard THR. The mean stiffness of the reconstructed pelvis was1738.6±200.3 Nmm−1compared to the intact pelvis, which was911.4±172.7 Nmm−1(Pvalue = 0.01). The mean load to failure for the standard acetabular cup construct was3297.3±117.7 N while that of the reconstructed pelvis with the acetabulum cage and threaded rods was4863.8±7.0 N.Conclusion. Reconstruction of the pelvis with an acetabular reconstruction cage and threaded rods is a biomechanical viable option.

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Epidemiology and survival analyses of 333 adult glioma patients from Eastern Algeria (2008-2016)

African Health Sciences ◽

10.4314/ahs.v20i3.29 ◽

2020 ◽

Vol 20 (3) ◽

pp. 1250-1258

Author(s):

Sabrina Touati ◽

Rachid Djekkoun ◽

Mohamed El-Hadef El-Okki ◽

Dalila Satta

Keyword(s):

Cox Model ◽

Survival Rates ◽

University Hospital ◽

Prognosis Factors ◽

Chi Square ◽

Oncological Treatment ◽

Kaplan Meier ◽

Chi Square Test ◽

The Mean ◽

Eastern Algeria

Background: Gliomas are a relatively rare group of tumors with a poor prognosis. We aimed to describe and analyze the clinical characteristics and survival of patients with glioma tumors of Eastern Algeria. Methods: A retrospective study was conducted at the University Hospital of Constantine. Medical records of patients enrolled between January 2008 and October 2016 were consulted. Demographic characteristics, clinical data, treatment strategy and dates of last follow-up or death were collected. Chi-square test was used for checking associations, Kaplan- Meier methodology for estimating the survival, and the cox model for identifying prognosis factors. Results: A total of 333 patients composed our cohort. The mean age was 48.07 years, and men were 1.87 times more frequent than women. High grade tumors were mainly observed among adults and old adults and in supra-tentorial locations. More than half of the patients had a large resection and a curative protocol of oncological treatment (50.7% and 57%, re- spectively). The mean overall survival was 45.4 months, the median was 21.7 months, and survival rates at 1-, 2-, and 5-years were: 62.8%, 48.5% and 32.9% respectively. Age, histology, grade of malignancy and oncological treatment were the major prognosis factors. Conclusion: Our sample was relatively young with a higher survival compared to others. Keywords: Glioma; epidemiology; Algeria.

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