Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity

2018 ◽  
Vol 100-B (11) ◽  
pp. 1442-1448 ◽  
Author(s):  
C. Hipfl ◽  
V. Janz ◽  
J. Löchel ◽  
C. Perka ◽  
G. I. Wassilew
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Postoperative Function ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Acetabular Bone Loss ◽  
The Mean

AimsSevere acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems.Patients and MethodsWe undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).ResultsThe cumulative five-year survivorship of the implant with revision for any cause was 89% (95% confidence interval (CI) 72 to 96) with eight hips at risk. No revision was required for aseptic loosening; however, one patient with one hip (3%) required removal of the ischial flange of the cage due to sciatic nerve irritation. Two patients (6%; two hips) suffered from hip dislocation, whereas one patient (one hip) required revision surgery with cement fixation of a dual-mobility acetababular component into a well-fixed cup-cage construct. Two patients (6%; two hips) developed periprosthetic infection. One patient was successfully controlled with a two-stage revision surgery, while the other patient underwent excision arthroplasty due to severe medical comorbidities. For the whole series, the Harris Hip Score significantly improved from a mean of 30 (15 to 51) preoperatively to 71 (40 to 89) at the latest follow-up (p < 0.001).ConclusionOur findings suggest that cup-cage reconstruction is a viable option for major segmental bone defects involving the posterior column and PD. It allows adequate restoration of the acetabulum centre with generally good stability and satisfactory postoperative function. Instability and infection remain drawbacks in these challenging revision cases. Cite this article: Bone Joint J 2018;100-B:1442–48.

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

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
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.

Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity

2021 ◽  
pp. 1-9
Author(s):  
Frank S. Fröschen ◽  
Thomas M. Randau ◽  
Nadine Gravius ◽  
Dieter C. Wirtz ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Treatment Failure ◽  
Implant Failure ◽  
Rheumatoid Disease ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Acetabular Bone Loss ◽  
Custom Made

BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5–120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.

Total hip arthroplasty in skeletal dysplasia

2003 ◽  
Vol 13 (3) ◽  
pp. 177-183 ◽  
Author(s):  
S.I.M. Umarji ◽  
M.B. Lee ◽  
M.F. Gargan ◽  
N.M.A. Portinaro ◽  
I.D. Learmonth
Keyword(s):  
Revision Surgery ◽  
Juvenile Chronic Arthritis ◽  
Chronic Arthritis ◽  
Developmental Dysplasia ◽  
Harris Hip Score ◽  
Hip Prostheses ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
The Mean

This study presents the results of 38 hip prostheses in 24 people of short stature (under 152 cm). A retrospective clinical and radiological study recording the diagnosis, age at reconstruction, height, weight, type of prostheses, length of follow-up, radiological appearances and patient satisfaction was performed. Harris hip scores were used to assess activities of daily living (1). All patients were under 152cm and their diagnoses included achondroplasia, spondyloepiphyseal dysplasia, multiple epiphyseal dysplasia, developmental dysplasia of the hip and juvenile chronic arthritis. The mean height of these patients was 135 cm (range: 109cm to 150cm). The mean age was 38 years (range: 19 to 75 years) with mean follow-up 67 months (range: 12 to 406 months). Only one patient, who is now aged 69 years (though 65 years at revision surgery), has required revision surgery to date. The results were excellent for 33 hips (Harris hip score between 80–100), good in three (Harris hip score between 70–80), satisfactory in one (score 60–70) and poor for one (Harris hip score <50). The mean Harris hip score to date is 89. Hip replacement surgery is difficult in this challenging group of patients but can nonetheless yield gratifying results in over 90% of cases.

Results at 10–24 years after single-stage revision arthroplasty of infected total hip arthroplasty in patients under 45 years of age

2019 ◽  
pp. 112070001988887 ◽  
Author(s):  
Matthias Wolff ◽  
Christian Lausmann ◽  
Thorsten Gehrke ◽  
Akos Zahar ◽  
Malte Ohlmeier ◽  
...  
Keyword(s):  
Infection Control ◽  
Revision Surgery ◽  
Single Stage ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Study Cohort ◽  
One Stage ◽  
The Mean

Introduction: The management of periprosthetic joint infection (PJI) of the hip is a challenging procedure. One-stage exchange is carried out in specialist centres with comparable infection free survival rates. However, there is a paucity of long-term results of this approach in young patients. Methods: All patients undergoing one-stage exchange due to PJI with a known causative organism ⩽45 years of age with a minimum of 10-year follow-up (mean 15 years; range 10–24 years) were enrolled in this retrospective study. Patients older than 45 years of age or patients with a two-stage procedure were excluded from the study. The primary outcome measure was failure rate with special focus on reinfection at latest follow-up. Failure was defined as revision surgery for infection. Furthermore, functional outcome using the Harris Hip Score was determined initially and at latest follow-up. 26 patients fulfilled the inclusion criteria and were available for final follow-up. Results: The study cohort consists of 16 male and 10 female patients with a mean age of 36.8 years (range 20–45 years) and a mean BMI of 29.8 kg/m2 (range 20.7–40.6 kg/m2). Prior to the single-stage procedure, the patients underwent an average of 3.1 previous surgical interventions (range 1–9). The mean hospital stay after septic revision was 19.7 days (11–33 days). Most infections were caused by Staphylococcus epidermidis ( n = 8, 30.8%), followed by Staph. aureus ( n = 7, 26.9%) and Propionibacterium acnes ( n = 6, 23.1%). At latest follow-up, the overall survival rate was 76.9 %, while infection control could be achieved in 96.2%. At final examination, the mean Harris Hip Score improved from 46.2 to 78.9 (range 18.0–99; SD, 22.6). Conclusions: Single-stage revision surgery for the management of PJI in patients ⩽45 years is a successful treatment option with high infection control, even after long-term follow-up.

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 73-77
Author(s):  
Loris Perticarini ◽  
Mario Mosconi ◽  
Marta Medetti ◽  
Laura Caliogna ◽  
Francesco M Benazzo
Keyword(s):  
Revision Surgery ◽  
Developmental Dysplasia ◽  
Modular System ◽  
Harris Hip Score ◽  
Metastatic Tumour ◽  
Leg Length ◽  
Short Term ◽  
Femoral Shortening ◽  
The Mean

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

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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