The mid-long term results of reconstructional cage and morselized allografts combined application for the Paprosky type III acetabular bone defects in revision hip arthroplasty

Abstract Background Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction. Methods We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation. Results All patients were followed up with a mean follow-up of 79.5 months (range 38–141), HHS improved from 31.4 (13–43) points preoperatively to 84.6 (55–94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. Conclusion The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.

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The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

International Orthopaedics ◽

10.1007/s00264-015-2965-6 ◽

2015 ◽

Vol 39 (10) ◽

pp. 2023-2030 ◽

Cited By ~ 26

Author(s):

Yuanqing Mao ◽

Chen Xu ◽

Jiawei Xu ◽

Huiwu Li ◽

Fengxiang Liu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Defects ◽

Revision Total Hip Arthroplasty ◽

Acetabular Bone ◽

Total Hip ◽

Type Iii ◽

Acetabular Bone Defects

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Abundant heterotopic bone formation following use of rhBMP-2 in the treatment of acetabular bone defects during revision hip arthroplasty

Arthroplasty Today ◽

10.1016/j.artd.2017.12.004 ◽

2018 ◽

Vol 4 (2) ◽

pp. 162-168 ◽

Cited By ~ 6

Author(s):

Alexander Arzeno ◽

Tim Wang ◽

James I. Huddleston

Keyword(s):

Bone Formation ◽

Hip Arthroplasty ◽

Bone Defects ◽

Revision Hip Arthroplasty ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Acetabular Bone ◽

Acetabular Bone Defects

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What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2020-26-2-31-49 ◽

2020 ◽

Vol 26 (2) ◽

pp. 31-49

Author(s):

R. M. Tikhilov ◽

A. A. Dzhavadov ◽

A. N. Kovalenko ◽

A. O. Denisov ◽

A. S. Demin ◽

...

Keyword(s):

Hip Arthroplasty ◽

Retrospective Cohort ◽

Defect Formation ◽

Bone Defects ◽

Revision Hip Arthroplasty ◽

Acetabular Defects ◽

Type 3 ◽

Revision Operations

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p<0.05) and its uncontained defects (p<0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p<0.05) and in the early stages of observation (p<0.05).Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

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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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Revision Total Hip Arthroplasty Using Tantalum Augment in Patients with Paprosky III or IV Acetabular Bone Defects: A Minimum 2-year Follow Up Study

Hip & Pelvis ◽

10.5371/hp.2016.28.2.98 ◽

2016 ◽

Vol 28 (2) ◽

pp. 98 ◽

Cited By ~ 6

Author(s):

Min Jeong ◽

Hyung-Joo Kim ◽

Seung-Jae Lim ◽

Young-Wan Moon ◽

Yoon-Soo Park

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Defects ◽

Revision Total Hip Arthroplasty ◽

Acetabular Bone ◽

Total Hip ◽

Follow Up Study ◽

Acetabular Bone Defects

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Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04694-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jacek Gagala

Keyword(s):

Bone Graft ◽

Revision Arthroplasty ◽

Bone Defects ◽

Bone Graft Substitute ◽

Acetabular Bone ◽

Total Hip ◽

Acetabular Bone Defects ◽

Bone Graft Substitutes ◽

Hip Arthroplasties

Abstract Background Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. Methods Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. Results The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. Conclusion Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

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