Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum

Aims The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d’Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725–32.

Download Full-text

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

Hip International ◽

10.1177/1120700019873617 ◽

2019 ◽

pp. 112070001987361 ◽

Cited By ~ 3

Author(s):

Jesús Moreta ◽

Iker Uriarte ◽

Xabier Foruria ◽

Ioar Urra ◽

Urko Aguirre ◽

...

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Recurrent Dislocation ◽

Revision Total Hip Arthroplasty ◽

Dual Mobility ◽

Total Hip ◽

Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

Download Full-text

Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

Advances in Orthopedics ◽

10.1155/2013/347358 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Mitsuyoshi Yamamura ◽

Nobuo Nakamura ◽

Hidenobu Miki ◽

Takashi Nishii ◽

Nobuhiko Sugano

Keyword(s):

Total Hip Arthroplasty ◽

Bone Cement ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Full Weight Bearing ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Revision Tha ◽

Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

Download Full-text

Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

BioMed Research International ◽

10.1155/2018/2364269 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hou-Tsung Chen ◽

Cheng-Ta Wu ◽

Tsan-Wen Huang ◽

Hsin-Nung Shih ◽

Jun-Wen Wang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Type Ii ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Press Fit ◽

Cementless Cup ◽

Revision Tha ◽

Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

Download Full-text

Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

Hip International ◽

10.1177/1120700020917125 ◽

2020 ◽

Vol 30 (1_suppl) ◽

pp. 7-11

Author(s):

Massimo Franceschini ◽

N Amir Sandiford ◽

Vincenzo Cerbone ◽

Lucio Cappelli Toledo de Araujo ◽

Daniel Kendoff

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Short Term ◽

Total Hip ◽

Antibacterial Coating ◽

Revision Tha ◽

Detailed Function ◽

New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

Download Full-text

Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499018783913 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878391 ◽

Cited By ~ 3

Author(s):

Jun-Dong Chang ◽

In-Sung Kim ◽

Sameer Ajit Mansukhani ◽

Vishwas Sharma ◽

Sang-Soo Lee ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Fourth Generation ◽

Harris Hip Score ◽

Revision Total Hip Arthroplasty ◽

Acetabular Cup ◽

Total Hip ◽

Revision Tha ◽

Ceramic On Ceramic

Purpose: The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. Methods: A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0–9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. Results: At the final follow-up examination, the average HHS was 90.4 (range, 67–100). The average WOMAC pain and physical function score were 2.8 (range, 0–12) and 16.4 (range, 0–42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. Conclusion: Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.

Download Full-text

Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1064 ◽

2016 ◽

Vol 6 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

Samuel S Wellman ◽

David E Attarian ◽

Taylor R McClellan ◽

Roberto D Calderon ◽

Paul F Lachiewicz

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Dislocation Rate ◽

Revision Total Hip Arthroplasty ◽

Short Term ◽

Dual Mobility ◽

Total Hip ◽

Increased Risk

ABSTRACT Patients undergoing a revision total hip arthroplasty (THA) are at increased risk for dislocation. The literature suggests dual-mobility components may decrease the frequency of dislocation. We conducted a retrospective study of one type of dual mobility acetabular component implanted in 82 revision THA cases that were considered at increased risk for dislocation. Of the 82 hips, 58 had a mean follow-up of 12 months (3–28 months). The indication for revision was instability in 18 hips (31%), adverse metal-on-metal reaction in 13 hips (22%), reimplantation for infection in 11 hips (19%), and aseptic loosening of the acetabular component in 9 hips (16%). In the course of follow-up, 6 hips developed a deep infection requiring reoperation. There were no early hip dislocations. McClellan TR, Calderon RD, Bolognesi MP, Attarian DE, Lachiewicz PF, Wellman SS. Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component. The Duke Orthop J 2016;6(1):17-20.

Download Full-text

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

Download Full-text

Radiolucent lines do not affect the longevity of highly cross-linked polyethylene cemented components in total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b10.bjj-2020-2298.r2 ◽

2021 ◽

Vol 103-B (10) ◽

pp. 1604-1610

Author(s):

Yusuke Takaoka ◽

Koji Goto ◽

Jiro Tamura ◽

Yaichiro Okuzu ◽

Toshiyuki Kawai ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Long Term Outcome ◽

Total Hip ◽

Radiolucent Lines ◽

Kaplan Meier ◽

Acetabular Components

Aims We aimed to evaluate the long-term outcome of highly cross-linked polyethylene (HXLPE) cemented acetabular components and assess whether any radiolucent lines (RLLs) which arose were progressive. Methods We retrospectively reviewed 170 patients who underwent 187 total hip arthroplasties at two hospitals with a minimum follow-up of ten years. All interventions were performed using the same combination of HXLPE cemented acetabular components with femoral stems made of titanium alloy. Kaplan-Meier survival analysis was performed for the primary endpoint of acetabular component revision surgery for any reason and secondary endpoint of the appearance of RLLs. RLLs that had appeared once were observed over time. We statistically assessed potential relationships between RLLs and a number of factors, including the technique of femoral head autografting and the Japanese Orthopaedic Association score. Results The mean follow-up period was 13.0 years (10.0 to 16.3). Femoral head autografting was performed on 135 hips (72.2%). One acetabular component was retrieved because of deep infection. No revision was performed for the aseptic acetabular loosening. The Kaplan-Meier survival curve for the primary and secondary endpoints were 98.2% (95% confidence interval (CI) 88.6% to 99.8%) and 79.3% (95% CI 72.8% to 84.6%), respectively. RLLs were detected in 38 hips (21.2%), at a mean of 1.7 years (1 month to 6 years) postoperatively. None of the RLLs were progressive, and the presence of RLLs did not show a significant association with the survival and clinical score. RLLs were more frequently observed in hips without femoral head autografts than in those with autografts. Conclusion The use of HXLPE cemented acetabular components in total hip arthroplasty demonstrated excellent clinical outcomes after ten years, and no RLLs were progressive, and their presence did not affect the outcome. Femoral head autografting did not negatively impact the acetabular component survival or the appearance of RLLs. Cite this article: Bone Joint J 2021;103-B(10):1604–1610.

Download Full-text