Acetabular reconstruction with impacted bone allografts and cemented acetabular components

SummaryThe treatment of loosened total hip replacement (THR) acetabular components may require the management of severe bone defects. Although being applied for decades, there is only limited scientific data about the osteointegration of cancellous bone allografts (CBA) and other void fillers. Monitoring of periprosthetic bone regeneration could possibly help to optimize this process thereby reducing late failure rates. The aim of this study was to show osteometabolic changes in periprosthetic CBA after THR revision with the use of sodium-[18F]-fluoride (NaF) and positron emission tomography (PET). Patients, methods: Twelve patients undergoing THR revision with the use of CBA were prospectively enrolled in the study. Nine patients completed all necessary examinations and were included in the evaluation. The temporal pattern of osteointegration was assessed via NaF-PET at one (PET1) and six weeks (PET2) after surgery. CBA, tantalum implants, supraacetabular regions ipsilateral and contralateral, and parasymphyseal pubic bones were delineated as volumes of interest (VOI) in postop CT scans, which were then merged with the PET data. Results: In comparison to the contralateral supraacetabular reference bone, a significant 1.5-fold increase of osteometabolic activity from PET1 to PET2 was seen in the CBA region. Also, the ipsilateral supraacetabular host bone showed a higher NaF-in- flux in week 6, compared to the first postoperative week. The supraacetabular site exhibited a significantly 1.8- to 2-fold higher influx and uptake than bone regions in non-operated sites. Tantalum implants had a low NaF influx at both time points investigated. Conclusion: Using NaF-PET osteometabolic changes of CBA and implant- bone-interfaces can be monitored. Applying this method we demonstrated early periprosthetic temporal bone regeneration patterns in THR cup revision patients.

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L5 Radiculopathy Secondary to Migration of a Revision Stemmed Acetabular Cup

Hip International ◽

10.5301/hipint.5000517 ◽

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.

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Dual-mobility bearings in complex revision hip arthroplasty

Hip International ◽

10.1177/1120700021999795 ◽

2021 ◽

pp. 112070002199979

Author(s):

Christopher P Wakeling ◽

Nemandra A Sandiford ◽

Rafia Ghani ◽

Simon J Bridle ◽

Philip A Mitchell ◽

...

Keyword(s):

Hip Arthroplasty ◽

High Risk Group ◽

Acetabular Reconstruction ◽

Dual Mobility ◽

Total Femoral Replacement ◽

Excision Arthroplasty ◽

Acetabular Components ◽

Constrained Liner ◽

Femoral Reconstruction

Background: Revision total hip arthroplasty (rTHA) is associated with an increased dislocation risk. Dual-mobility (DM) bearings have been used to address this issue. Such constructs offer increased range of motion and enhanced stability whilst avoiding some issues associated with fully-constrained devices. DM bearings have been used in our unit since 2013. Methods: All rTHA cases since 2013 were reviewed using the following criteria: (1) use of a DM bearing; (2) extensive soft tissue or bone loss resulting from ARMD, infection or multiple revisions, or requiring custom or megaprosthetic reconstruction; (3) minimum 2-month follow-up. Results: 52 cases were identified with a median of 2 previous operations (range 1–6) and mean follow-up of 14 (2–41) months. The Novae-Stick component was used in 50 cases, the Avantage in 2 and the Trident MDM in 1 case. 19 required acetabular reconstruction using trabecular metal and four required custom acetabular components. 19 required femoral reconstruction with a proximal or total femoral replacement. Postoperatively, 8 patients (15.4%) sustained a dislocation at a mean of 1.6 (range 1–3) months. 3 (5.8%) requiring re-revision. 1 required excision arthroplasty and 2 a constrained liner, 1 of which went on to have further instability. There were no intraprosthetic dislocations. Conclusions: Dual-mobility components are a viable option in the complex rTHA setting. Early dislocations can occur but the rate of instability is acceptable in this high-risk group.

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The biological acetabular reconstruction with bone allografts in hip revision arthroplasty

MUSCULOSKELETAL SURGERY ◽

10.1007/s12306-018-0573-5 ◽

2018 ◽

Vol 103 (2) ◽

pp. 173-179

Author(s):

L. Busanelli ◽

F. Castagnini ◽

B. Bordini ◽

S. Stea ◽

P. P. Calderoni ◽

...

Keyword(s):

Revision Arthroplasty ◽

Acetabular Reconstruction ◽

Hip Revision ◽

Hip Revision Arthroplasty ◽

Bone Allografts

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Uncemented Acetabular Components with Femoral Head Autograft for Acetabular Reconstruction in Developmental Dysplasia of the Hip

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.n.00061 ◽

2014 ◽

Vol 96 (22) ◽

pp. 1878-1882 ◽

Cited By ~ 24

Author(s):

Matthew P Abdel ◽

Louis S Stryker ◽

Robert T Trousdale ◽

Daniel J Berry ◽

Miguel E Cabanela

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Acetabular Reconstruction ◽

Acetabular Components ◽

Dysplasia Of The Hip

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Poster #6 Uncemented acetabular components with structural femoral head autografts for acetabular reconstruction in developmental dysplasia of the hip: Results at five to twelve years

The Journal of Arthroplasty ◽

10.1016/s0883-5403(99)90180-8 ◽

1999 ◽

Vol 14 (2) ◽

pp. 259

Author(s):

Mark J. Spangehl ◽

Daniel J. Berry ◽

Robert T. Trousdale ◽

Miguel E. Cabanela

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Acetabular Reconstruction ◽

Acetabular Components ◽

Dysplasia Of The Hip

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The Repair and Healing of Two Traumatic Ilial Body Fractures Adjacent to Cemented Total Hip Acetabular Components

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633073 ◽

1992 ◽

Vol 05 (02) ◽

pp. 85-89

Author(s):

P. K. Shires ◽

T. L. Dew

Keyword(s):

Internal Fixation ◽

Cancellous Bone ◽

Surgical Techniques ◽

Autogenous Bone ◽

Cancellous Bone Graft ◽

Standard Methods ◽

Intravenous Antibiotics ◽

Prophylactic Use ◽

Acetabular Components ◽

Autogenous Bone Grafts

SummaryThis report has documented the repair and healing of two ilial fractures in dogs which were compounded by the presence of a cemented acetabular prosthesis. While specific recommendations can not be made from such a small number of cases, the information presented herein suggests that such fractures will heal without complication if aseptic surgical techniques and standard methods of internal fixation are employed. The authors strongly recommend the prophylactic use of intravenous antibiotics and the placement of cancellous bone graft when the repair of such fractures is attempted.Two traumatic ilial fractures involving the cement/bone interface of acetabular prostheses were repaired using lag screws, cerclage wires, and autogenous bone grafts. The fractures healed and ambulatory function was regained.

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