The patient-specific Triflange acetabular implant for revision total hip arthroplasty in patients with severe acetabular defects

Aims Few reconstructive techniques are available for patients requiring complex acetabular revisions such as those involving Paprosky type 2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was to describe the development of the patient specific Triflange acetabular component for use in these patients, the surgical technique and mid-term results. We include a description of the pre-operative CT scanning, the construction of a model, operative planning, and surgical technique. All implants were coated with porous plasma spray and hydroxyapatite if desired. Patients and Methods A multicentre, retrospective review of 95 complex acetabular reconstructions in 94 patients was performed. A total of 61 (64.2%) were female. The mean age of the patients was 66 (38 to 85). The mean body mass index was 29 kg/m2 (18 to 51). Outcome was reported using the Harris Hip Score (HHS), complications, failures and survival. Results The mean follow-up was 3.5 years (1 to 11). The mean HHS improved from 46 (15 to 90) pre-operatively to 75 (14 to 100). A total of 21 hips (22%) had at least one complication with some having more than one; including dislocation (6%), infection (6%), and femoral complications (2%). The implant was subsequently removed in five hips (5%), only one for suspected aseptic loosening. Conclusion The Triflange patient specific acetabular component provides predictable fixation with complication rates which are similar to those of other techniques. Cite this article: Bone Joint J 2018;100-B(1 Supple A):50–4.

Download Full-text

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1668149 ◽

2018 ◽

Vol 29 (01) ◽

pp. 033-038 ◽

Cited By ~ 4

Author(s):

M. Klora ◽

J. Zeidler ◽

S. Eberhard ◽

S. Bassler ◽

S. Mayer ◽

...

Keyword(s):

Surgical Technique ◽

Ureteropelvic Junction Obstruction ◽

Length Of Hospital Stay ◽

Ureteropelvic Junction ◽

Treatment Modalities ◽

Complication Rates ◽

Laparoscopic Pyeloplasty ◽

Small Children ◽

The Mean ◽

Open Pyeloplasty

Introduction Surgery for ureteropelvic junction obstruction (UPJO) is performed by both pediatric surgeons (PS) and urologists (URO). The aim of this study was to analyze treatment modalities for UPJO and results in relation to the surgical technique and the operating discipline in Germany. Materials and Methods Data of patients aged 0 to 18 years were extracted from a major public health insurance (covering ∼5.7 million clients) during 2009 to 2016 and were analyzed for sociodemographic variables, surgical technique, and treating discipline. Logistic regression analysis was performed for the risk of a complication within the first postoperative year. Results A total of 229 children (31.0% female) were included. Laparoscopic pyeloplasty (LP) was performed in 58 (25.3%) patients (8.6 ± 6.4 years), and open pyeloplasty (OP) was applied in 171 (74.7%; 4.6 ± 5.9 years). LP was the dominant technique in females (p < 0.02); males preferentially underwent OP (p < 0.02). Length of hospital stay was 4.3 days (p = 0.0005) shorter in LP compared with that in OP, especially in children ≤ 2 years (6.7 days, p = 0.007). PS operated on 162 children (70.7%), and URO performed surgery on 67 patients (29.3%). The mean age of children operated by PS (3.5 ± 4.7 years) was significantly younger compared with that operated by URO (10.8 ± 6.5 years, p < 0.0001). Complication rates were independent of surgical technique or treating specialty. Conclusion In Germany, UPJO was treated by LP in 25.3% of patients, which was associated with a shorter length of stay, especially in children ≤ 2 years. Complication rates were independent of the operating specialty and surgical technique. Therefore, LP should be further promoted for the treatment of UPJO in small children.

Download Full-text

The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up

Hip International ◽

10.1177/1120700018760817 ◽

2018 ◽

Vol 28 (6) ◽

pp. 668-674 ◽

Cited By ~ 15

Author(s):

David C Kieser ◽

Ramez Ailabouni ◽

Sandra C J Kieser ◽

Michael C Wyatt ◽

Paul C Armour ◽

...

Keyword(s):

New Technology ◽

Deep Infection ◽

Harris Hip Score ◽

Patient Specific ◽

Outcome Analysis ◽

Bone Contact ◽

Functional Scores ◽

3D Printed ◽

Acetabular Implant

Introduction: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. Methods: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Results: Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. Conclusions: The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

Download Full-text

Preliminary results of a 3D-printed acetabular component in the management of extensive defects

Hip International ◽

10.5301/hipint.5000561 ◽

2017 ◽

Vol 28 (3) ◽

pp. 266-271 ◽

Cited By ~ 16

Author(s):

Mustafa Citak ◽

Lilly Kochsiek ◽

Thorsten Gehrke ◽

Carl Haasper ◽

Eduardo M Suero ◽

...

Keyword(s):

Bone Loss ◽

Acetabular Component ◽

Complication Rate ◽

Primary Outcome Measure ◽

Patient Specific ◽

Component Technique ◽

Revision Tha ◽

3D Printed ◽

Acetabular Defects ◽

Acetabular Components

Introduction: The treatment of extensive bone loss and massive acetabular defects can be compounded by several challenges and pitfalls. The survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The goal of the present study was to analyse the outcomes of 3D-printed patient-specific acetabular components in the management of extensive acetabular defects and combined pelvic discontinuity (PD). Methods: 9 patients underwent revision THA using 3D-printed custom acetabular components to reconstruct extensive acetabular defects. The Paprosky classifications were determined in all patients. The primary outcome measure was the implant-associated failure rate. Results: 1 out of 9 patients suffered an implant-associated complication (11%). The overall implant-associated survival rate was 89%. The overall complication rate was 56%. Conclusions: The patient-specific acetabular component technique shows promise for the treatment of patients with severe acetabular defects in revision THA. Further research aimed at reducing costs and improving the complication rate are warranted.

Download Full-text

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.

Download Full-text

Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur

Hip International ◽

10.1177/1120700018761519 ◽

2018 ◽

Vol 29 (1) ◽

pp. 58-64 ◽

Cited By ~ 2

Author(s):

Jonathan R Manara ◽

John A Mathews ◽

Harvey S Sandhu

Keyword(s):

Plate Fixation ◽

Periprosthetic Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Reproducible Method ◽

The Mean ◽

Modified Harris Hip Score ◽

Unified Classification System ◽

Hip Arthroplasties

Background: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. Purpose: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. Methods: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). Results: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. Conclusion: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.

Download Full-text

Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya

ISRN Plastic Surgery ◽

10.5402/2013/268094 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

F. W. Nangole ◽

S. O. Khainga

Keyword(s):

Surgical Technique ◽

Complication Rate ◽

Cleft Lip ◽

Surgical Techniques ◽

Complication Rates ◽

Outreach Programs ◽

Bilateral Cleft Lip ◽

The Mean ◽

One Year ◽

Cleft Surgery

This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series.

Download Full-text

Hip resurfacing with a highly cross-linked polyethylene acetabular liner and a titanium nitride-coated femoral component

Hip International ◽

10.1177/1120700017752334 ◽

2018 ◽

Vol 28 (4) ◽

pp. 422-428 ◽

Cited By ~ 2

Author(s):

James W Pritchett

Keyword(s):

Titanium Nitride ◽

Femoral Component ◽

Acetabular Component ◽

Polyethylene Wear ◽

Hip Resurfacing ◽

Harris Hip Score ◽

Kaplan Meier ◽

Joint Biomechanics ◽

Cementless Femoral Component ◽

The Mean

Aims: This study evaluated a specific hip resurfacing system to determine the: (1) function and complications, (2) implant survivorship, (3) acetabular bone conservation and joint biomechanics and (4) osteolysis and polyethylene wear. Methods: I performed 234 resurfacing procedures (192 patients) using a two-piece titanium acetabular component with a 4 mm highly cross-linked polyethylene liner and a cementless titanium nitride-coated titanium femoral component. Function was assessed with Harris Hip, WOMAC, SF-12, and UCLA scores. Radiography and CT scans were used to evaluate bone retention, component position, joint biomechanics, and osteolysis. Retrieved polyethylene liners were analyzed for wear. Results: Median follow-up was 8 years and patients averaged 48 years of age at surgery. The mean Harris Hip Score was 96 and all scores improved significantly. Kaplan-Meier survivorship was 97%. The mean medial acetabular thickness was 9 mm postoperatively versus 14 mm preoperatively ( p = 0.019). Femoral bone conservation (head:neck ratio) was 1.36 postoperatively versus 1.42 preoperatively ( p = 0.02). There was no polyethylene wear through or osteolysis. Eight polyethylene retrievals had a mean wear of 0.05 mm/yr. Conclusions: Resurfacing with a highly cross-linked polyethylene acetabular component and a titanium nitride-coated titanium cementless femoral component is a reliable and bone-conserving procedure at mid-term.

Download Full-text

A double mobility acetabular implant for primary hip arthroplasty in patients at high risk of dislocation

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925058391 ◽

2014 ◽

Vol 96 (8) ◽

pp. 597-601 ◽

Cited By ~ 8

Author(s):

NL Vasukutty ◽

RG Middleton ◽

P Young ◽

C Uzoigwe ◽

B Barkham ◽

...

Keyword(s):

High Risk ◽

Acetabular Component ◽

Polyethylene Wear ◽

Large Diameter ◽

Wear Rates ◽

Total Hip ◽

Hip Function ◽

The Mean ◽

Acetabular Implant

Introduction Dislocation following total hip replacement continues to be a problem for which no completely satisfactory solution has been found. Several methods have been proposed to reduce the incidence of hip dislocations with varying degrees of success, including elevated rim liners, constrained liners and large diameter bearings. We present our experience with the double mobility acetabular component in patients at high risk of instability. Methods This was a retrospective review of 65 primary total hip arthroplasties in 55 patients (15 men, 40 women), performed between October 2005 and November 2009. The majority (80%) of patients had at least two and 26% had at least three risk factors for instability. The mean age was 76 years (range: 44–92 years). The patients were followed up for a mean duration of 60 months (range: 36–85 months). Results Fourteen patients died and one was lost to follow-up, leaving fifty hips for final assessment. Until the final follow-up appointment, no patients had dislocation and none required revision surgery. The mean Oxford hip score improved from 45.0 to 26.5 (p<0.0001). The mean Merle d’Aubigné pain score improved from 1.4 to 4.9 (p<0.0001), the walking score from 2.3 to 3.1 (p<0.07) and the absolute hip function score from 5.4 to 10.8 (p<0.0001). There were no clinical or radiographic signs of loosening. Conclusions The double mobility acetabular component was successful at preventing dislocation during early to medium-term follow-up. However, as data are still lacking with regard to polyethylene wear rates at the additional bearing surface, it would be prudent to restrict the use of this implant to selected patients at high risk of instability.

Download Full-text

Medial Placement of a Cementless Acetabular Component in a Modern Alumina-on-Alumina THA

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.330-332.1243 ◽

2007 ◽

Vol 330-332 ◽

pp. 1243-1246

Author(s):

Jeong Joon Yoo ◽

Hee Joong Kim ◽

Young Min Kim ◽

Kang Sup Yoon ◽

Kyung Hoi Koo ◽

...

Keyword(s):

Acetabular Component ◽

Polyethylene Wear ◽

Clinical Results ◽

Harris Hip Score ◽

Bearing Surface ◽

The Mean ◽

Acetabular Components ◽

Cementless Acetabular Component ◽

Acetabular Wall

Medial placement of a cementless acetabular component into or beyond the medial wall of a shallow, dysplastic acetabulum is a technique to enhance its coverage during difficult total hip arthroplasty (THA). Dysplastic hips almost always need small size of acetabular component, so an accelerated polyethylene wear can occur when a conventional bearing surface is used. Modern alumina-on-alumina couplings can be an alternative for these patients. We evaluated the clinical results of 43 medially placed cementless acetabular components (PLASMACUP®SC) incorporating a modern alumina bearing surface (BIOLOX® forte). Acetabular components were inserted medially beyond the ilioischial line and, therefore, beyond the level of the cortical bone of the cotyloid notch, and followed up for more than 5 years (range, 60 – 93 months). In 14 hips, the medial acetabular wall was perforated purposefully and the medial aspect of the cup was placed beyond both the ilioischial and the iliopubic line on radiographs. The mean Harris hip score improved from 55.3 points preoperatively to 94.5 points postoperatively. Postoperatively, the hip center migrated 12.1 mm medially and 1.5 mm inferiorly. The average amount of cup protrusion beyond the ilioischial and the iliopubic line was 3.1 mm and 1.9 mm, respectively. The average superolateral coverage of the cup was 98.5 percent. During follow-up, no osteolysis or loosening of acetabular components was observed and no revision was required. Medial placement of a cementless acetabular component into or beyond the medial acetabular wall offers predictable clinical results and durable fixation in modern alumina-on-alumina THA.

Download Full-text

Outside-in arthroscopic psoas release for anterior iliopsoas impingement after primary total hip arthroplasty

Hip International ◽

10.1177/1120700020909159 ◽

2020 ◽

pp. 112070002090915

Author(s):

Jesús Moreta ◽

Adrián Cuéllar ◽

Urko Aguirre ◽

Óscar L Casado-Verdugo ◽

Alberto Sánchez ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Groin Pain ◽

High Rate ◽

Harris Hip Score ◽

Total Hip ◽

The Mean ◽

Hip Flexion ◽

Rate Of Success

Purpose: 1 of the causes of groin pain after total hip arthroplasty (THA) is impingement of the iliopsoas tendon. The purpose of this study was to present our results with outside-in arthroscopic tenotomy for iliopsoas impingement after THA. Methods: We retrospectively reviewed 12 patients treated between 2009 and 2016 with a minimum follow-up of 2 years. Anterior acetabular component prominence was measured on a true lateral hip radiograph. A transcapsular tenotomy was performed near the edge of the acetabular component through an outside-in arthroscopic approach. The primary clinical outcomes evaluated were groin pain, assessed with a visual analogue scale (VAS), and the Harris Hip Score (HHS). Secondary outcomes included strength of hip flexion, measured with the Medical Research Council (MRC) scale. Results: All patients had groin pain improvement, though one patient continued to have moderate pain. The mean VAS score was significantly lower postoperatively (1.08) than preoperatively (6.2) ( p < 0.001). The mean HHS improved from 58.8 (range, 37–76) to 86.1 (range, 59–98) ( p = 0.001). The average postoperative MRC Scale was 4.58. The mean anterior prominence was 7.25 mm (range 3–12 mm). In patients with <10 mm of component prominence, tenotomy provided groin pain resolution in all cases ( n = 8). In patients with ⩾10 mm of prominence, symptoms resolved in 3 out of 4 cases. Conclusions: Outside-in arthroscopic iliopsoas release provided a high rate of success with no complications in this study, even in patients with moderate acetabular component prominence.

Download Full-text