scholarly journals Multicup reconstruction technique for the management of severe protrusio acetabular defects

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Baochao Ji ◽  
Guoqing Li ◽  
Xiaogang Zhang ◽  
Yang Wang ◽  
Wenbo Mu ◽  
...  
Keyword(s):  
Survival Rate ◽  
Bone Ingrowth ◽  
Harris Hip Score ◽  
Reconstruction Technique ◽  
High Survival ◽  
Level Of Evidence ◽  
Therapeutic Study ◽  
Acetabular Defects ◽  
Acetabular Components ◽  
Acetabular Loosening

Abstract Background In revision hip arthroplasty, managing the large protrusio acetabular defects remains a challenge. The report described a novel technique which employs a trabecular metal revision shell as a super-augment to buttress the superior medial structure. Methods Between January 2015 and December 2018, the multicup reconstruction was performed in 21 patients with severe protrusio acetabular defects. The revision shell, plus two similar porous acetabular components was implanted into the initial shell to create a “multicup” construct. The functional outcomes were evaluated in terms of the Harris Hip Score. Acetabular loosening, restoration of hip center of rotation, and bone ingrowth etc., were radiographically assessed. The survival rate of the implants was also evaluated. Results A followup lasting a mean time of 31 months (range, 18–57 months) revealed that the average Harris Hip Score improved from preoperative 37.0 ± 7.1 to postoperative 76.4 ± 9.0. There were no revisions due to acetabular loosening. The horizontal offset increased by an average of 14 mm, and the vertical offset decreased by an average of 18 mm. Eighteen of the 21 patients (86 %) met at least 3 of 5 criteria associated with bone ingrowth. The survivorship free from re-revision for acetabular loosening after 2 years was 100 %. Conclusions The multicup reconstruction technique was a simplified re-revision procedure for managing the severe protrusio acetabular defects and could achieve a high survival rate. Level of evidence Therapeutic study, Level IVa.

scholarly journals Functional and Radiological Outcomes After Treatment with Custom-Made Acetabular Components in Patients with Paprosky type 3 Acetabular Defects: Short-Term Results

2020 ◽  
Author(s):  
Michael Stephan Gruber ◽  
Michael Jesenko ◽  
Julia Burghuber ◽  
Josef Hochreiter ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Special Treatment ◽  
Level Of Evidence ◽  
Custom Made ◽  
Significant Difference ◽  
Oxford Hip Score ◽  
Acetabular Defects ◽  
Type 3 ◽  
Acetabular Components

Abstract BackgroundSevere acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects.MethodsSixteen patients were included in this trial, nine of whom completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics.ResultsThe mean follow-up time of the nine patients was 13.6 months (± 5.6 SD). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed no significant difference in offset measurements except for femoral offset (41.8 mm on the contralateral and 35.2 mm on the treated hip, p = 0.044).ConclusionsThe functional and radiological outcomes are promising. However, long-term outcomes still need to be examined.Level of Evidence: Therapeutic Level IV.

scholarly journals Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Marta Medetti ◽  
Francesco Benazzo
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Type Ii ◽  
Level Of Evidence ◽  
Kaplan Meier ◽  
Prospective Case Series ◽  
Acetabular Components

Abstract Background This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. Methods Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29–90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. Results Average follow-up was 91 (range 24–146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25–70; SD 9) preoperatively to 84.4 (range 46–99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan–Meier survivorship was assessed to be 88.54% (95% CI 80.18–93.52%) at 71 months, with failure of the cup for any reason as the endpoint. Conclusion Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. Level of evidence Level IV prospective case series

scholarly journals Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results

2020 ◽  
Author(s):  
Michael Stephan Gruber ◽  
Michael Jesenko ◽  
Julia Burghuber ◽  
Josef Hochreiter ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Special Treatment ◽  
Center Of Rotation ◽  
Custom Made ◽  
Significant Difference ◽  
Oxford Hip Score ◽  
Acetabular Defects ◽  
Type 3 ◽  
Acetabular Components

Abstract Background Severe acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects.Methods Sixteen patients were eligible for this trial, nine of whom agreed to be included. All of them completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics.Results The mean follow-up time of the nine patients was 12.2 months (range: 10 - 18). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed restoration of the height of the center of rotation and of the global offset. Significant difference was detected in the femoral offset.Conclusions The functional and radiological outcomes are promising. However, long-term outcomes still need to be examined.Level of Evidence: Therapeutic Level IV.

scholarly journals Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael S. Gruber ◽  
Michael Jesenko ◽  
Julia Burghuber ◽  
Josef Hochreiter ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Special Treatment ◽  
Center Of Rotation ◽  
Custom Made ◽  
Significant Difference ◽  
Oxford Hip Score ◽  
Acetabular Defects ◽  
Type 3 ◽  
Acetabular Components

Abstract Background Severe acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects. Methods Sixteen patients were eligible for this trial, nine of whom agreed to be included. All of them completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics. Results The mean follow-up time of the nine patients was 12.2 months (range: 10–18). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed restoration of the height of the center of rotation and of the global offset. Significant difference was detected in the femoral offset. Conclusions The functional and radiological outcomes are promising. However, long-term outcomes still need to be examined. Level of evidence Therapeutic Level IV.

L5 Radiculopathy Secondary to Migration of a Revision Stemmed Acetabular Cup

2017 ◽  
Vol 27 (5) ◽  
pp. e7-e10
Author(s):  
Jesús Moreta ◽  
Oscar L. Casado-Verdugo ◽  
Fernando Labayru
Keyword(s):  
Facet Joint ◽  
Acetabular Reconstruction ◽  
Complication Rates ◽  
Acetabular Cup ◽  
Pelvic Discontinuity ◽  
Proximal Migration ◽  
Radicular Symptoms ◽  
Acetabular Defects ◽  
Acetabular Components ◽  
Acetabular Loosening

Introduction Stemmed acetabular components are used in patients undergoing revision total hip arthroplasty in cases with major acetabular defects or pelvic discontinuity. Conflicting results relating to the survival of the component, and complication rates are reported in the literature. We present a case of L5 radiculopathy secondary to proximal migration of this device. Case description A 79-year-old man was admitted to our department in 2012 with increasing pain and paresthesias, initially diagnosed as left L5 radiculopathy. In 2002, he had undergone revision surgery due to aseptic loosening of the acetabular component with a stemmed acetabular cup. Radiological findings were severe osteolysis around the acetabular cup with proximal migration. MRI showed osteolysis involving the left L5/S1 facet joint and evidence of soft tissue in the left foramina encasing the L5 radicular nerve. Nerve conduction and electromyography studies revealed chronic L5 radiculopathy. Discussions This case report illustrates the importance of considering acetabular loosening in a patient presenting with radicular symptoms. If a stemmed acetabular cup is chosen for an acetabular reconstruction, careful surgical technique should be employed in order to achieve durable fixation. If the patient has pelvic discontinuity, other options of reconstruction have showed better outcomes in the literature.

scholarly journals Extensively hydroxyapatite-coated long femoral stem revision hip arthroplasty: Clinical outcome and survivorship in 11 to 17.5 years follow up

2021 ◽  
pp. 221049172098511
Author(s):  
Liu Wing Hong ◽  
Chung Kwong Yin ◽  
Cheung Kin Wing ◽  
Chiu Kwok Hing ◽  
Ho Ki Wai Kevin
Keyword(s):  
Survival Rate ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
High Survival ◽  
Stem Revision ◽  
The Mean

Extensively coated long femoral stem revision hip arthroplasty is based on the principle of distal fixation at diaphyseal region, which can overcome the problem of proximal femoral bone stock deficiencies causing inadequate support and unstable fixation when using conventional length femoral stem. We performed a retrospective cohort analysis of 43 cases of revision hip arthroplasties using extensively hydroxyapatite-coated long femoral stem performed in our department from Jan 1998 to Dec 2005. Patients’ background demographic data, operative details and clinical outcome were analyzed. The mean age at revision surgery was 63.7 (32–84). The mean follow-up period was of 13.8 years (11–17.5 years). In the latest follow up, all patients reported either no or mild hip or thigh pain. 29.2% of patients were able to walk unaided, 25.0% were able to walk with stick, and 33.3% were able to walk with quadripod. The average Harris hip score measured in the latest follow up was 78.8 (55–100). 4.7% were complicated with implant loosening requiring re-revision and 4.7% were complicated with implant infection requiring implant removal. The survival rate was 89.9% at 17.5 years. The femoral stem without femoral fixation augmentation had better survivorship as compared with those with augmentation (p = 0.038). Extensively hydroxyapatite-coated long femoral stem is a good option for revision hip arthroplasty with good clinical outcome and high survival rate.

scholarly journals Long-Term Survival after Microfracture and Mosaicplasty for Knee Articular Cartilage Repair: A Comparative Study Between Two Treatments Cohorts

Cartilage ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Eirik Solheim ◽  
Janne Hegna ◽  
Eivind Inderhaug
Keyword(s):  
Articular Cartilage ◽  
Survival Rate ◽  
Cartilage Repair ◽  
Time To Failure ◽  
Level Of Evidence ◽  
Term Survival ◽  
Kaplan Meier ◽  
Osteochondral Autograft Transfer ◽  
Therapeutic Study

Objective To investigate survival of cartilage repair in the knee by microfracture (MFX; n = 119) or mosaicplasty osteochondral autograft transfer (OAT; n = 84). Design For survival analyses, “failure” was defined as the event of a patient reporting a Lysholm score <65 or undergoing an ipsilateral knee replacement. The Kaplan-Meier method was used for construction of a survival functions plot for the event “failure.” Log rank (Mantel-Cox) test was used for comparison of survival distributions in the 2 groups. Results The long-term failure rate (62% overall) was significantly higher in the MFX group (66%) compared with the OAT group (51%, P = 0.01). Furthermore, the mean time to failure was significantly shorter ( P < 0.001) in the MFX group, 4.0 years (SD 4.1) compared with the OAT group, 8.4 years (SD 4.8). In the OAT group, the survival rate stayed higher than 80% for the first 7 years, and higher than 60% for 15 years, while the survival rate dropped to less than 80% within 12 months, and to less than 60% within 3 years in the MFX group, log rank (Mantel-Cox) 20.295 ( P < 0.001). The same pattern was found in a subgroup of patients ( n = 134) of same age (<51 years) and size of treated lesion (<500 mm2), log rank (Mantel-Cox) 10.738 ( P = 0.001). The nonfailures (48%) were followed for median 15 yeas (1-18 years). Conclusions MFX articular cartilage repairs failed more often and earlier than the OAT repairs, both in the whole cohort and in a subgroup of patients matched for age and size of treated lesion, indicating that the OAT repair is the more durable. Level of evidence Therapeutic study, Level III.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

scholarly journals Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712199491
Author(s):  
Alberto Grassi ◽  
Gian Andrea Lucidi ◽  
Giuseppe Filardo ◽  
Piero Agostinone ◽  
Luca Macchiarola ◽  
...  
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Final Analysis ◽  
Activity Level ◽  
Long Term Results ◽  
Level Of Evidence ◽  
Unicompartmental Knee Arthroplasties ◽  
Tegner Score

Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.

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