Revision of the Acetabular Component without Cement After a Previous Acetabular Reconstruction with Use of a Bulk Femoral Head Graft in Patients Who Had Congenital Dislocation or Dysplasia. A Follow-up Note*

1999 ◽  
Vol 81 (12) ◽  
pp. 1703-6 ◽  
Author(s):  
B. SONNY BAL ◽  
TED MAURER ◽  
WILLIAM H. HARRIS
Keyword(s):  
Femoral Head ◽  
Acetabular Component ◽  
Acetabular Reconstruction ◽  
Congenital Dislocation

scholarly journals The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095710
Author(s):  
Arif Jan Hamrayev ◽  
Mehmet Ozbey Buyukkuscu ◽  
Abdulhamit Misir ◽  
Sukru Sarper Gursu
Keyword(s):  
Femoral Head ◽  
Acetabular Component ◽  
Hip Dislocation ◽  
Hip Osteoarthritis ◽  
Acetabular Reconstruction ◽  
Acetabular Coverage ◽  
Acetabular Cup ◽  
Developmental Hip Dysplasia ◽  
The Mean

Purpose: To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. Methods: Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18–76) years. The mean follow-up duration was 76 ± 25 (range 25–161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. Results: The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30–48°) with mean graft coverage of 34 ± 4.8% (range 24–46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. Conclusion: In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.

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

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.

Long-term results of acetabular reconstruction using irradiated allograft bone

2018 ◽  
Vol 100-B (11) ◽  
pp. 1449-1454 ◽  
Author(s):  
C. M. Green ◽  
S. C. Buckley ◽  
A. J. Hamer ◽  
R. M. Kerry ◽  
T. P. Harrison
Keyword(s):  
At Risk ◽  
Aseptic Loosening ◽  
Acetabular Component ◽  
Long Term Results ◽  
Acetabular Reconstruction ◽  
Allograft Bone ◽  
Patients At Risk ◽  
Irradiated Allograft

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

scholarly journals Multiple Acetabular Revisions in THA - Poor Outcome Despite Maximum Effort

2012 ◽  
Vol 6 (1) ◽  
pp. 488-494 ◽  
Author(s):  
O Bischel ◽  
JB Seeger ◽  
M Krüge ◽  
BG Bitsch
Keyword(s):  
Acetabular Component ◽  
Rank Test ◽  
Acetabular Reconstruction ◽  
Consecutive Series ◽  
Worst Case ◽  
Cumulative Survival ◽  
Number Of Patients ◽  
Maximum Effort ◽  
The Mean

A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d’Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination.Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term.

scholarly journals Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip

2021 ◽  
Author(s):  
Dominik Kaiser ◽  
Emanuel Ried ◽  
Patrick O. Zingg ◽  
Stefan Rahm
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Developmental Dysplasia ◽  
Acetabular Reconstruction ◽  
Secondary Osteoarthritis ◽  
Total Hip

Abstract Background Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. Methods A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. Results 24 patients (29 hips) with a mean age of 43 (18–75) years and a mean follow-up of 35 months (12–137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0–23) and significantly medialized by a mean of 18 mm (6–29). The bone graft was fully integrated after 12 months in all cases. Conclusion Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.

Revision of a canine Zürich cementless total hip replacement using a ‘Cupless’ system

2020 ◽  
Vol 8 (2) ◽  
pp. e001035
Author(s):  
Ronald S Olsen ◽  
Otto I Lanz
Keyword(s):  
Femoral Head ◽  
Total Hip Replacement ◽  
Acetabular Component ◽  
Hip Replacement ◽  
Total Hip ◽  
Replacement System ◽  
One Year ◽  
Owner Satisfaction ◽  
High Degree

A 6-year-old spayed female pit bull mix developed lameness secondary to aseptic loosening of the acetabular component from a total hip replacement (THR) performed at 1 year of age with the standard Zürich cementless THR (Z-THR) system. It was treated by removing the acetabular component and replacing the standard femoral head prosthesis with the larger ‘Cupless’ femoral head. The acetabulum was reamed to accommodate it. The new prosthesis articulated directly with the reamed bone. One year later, the patient had no perceptible lameness and stable implants. Subsequent follow-up found appropriate ambulation and a high degree of owner satisfaction. The Zürich ‘Cupless’ hip replacement system aims to reduce some of the challenges associated with traditional THR. Though functional outcomes have not been scientifically compared with traditional THR, this case suggests it could be considered as an alternative to traditional THR procedures or for revision in cases with aseptic cup loosening.

scholarly journals Hip Arthroplasty in Patients with Hip Dysplasia by Individual Augments: Early Results

2020 ◽  
Vol 26 (2) ◽  
pp. 50-59
Author(s):  
Ya. A. Rukin ◽  
A. V. Lychagin ◽  
V. Yu. Murylev ◽  
A. V. Garkavi ◽  
D. A. Tarasov ◽  
...  
Keyword(s):  
Femoral Head ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Hip Dysplasia ◽  
Harris Hip Score ◽  
Center Of Rotation ◽  
Anatomical Position ◽  
Early Results ◽  
Acetabular Components

Relevance. The altered hip anatomy makes total hip arthroplasty in patients with hip dysplasia a difficult and non-standard task. The acetabulum is deformed with femoral head in subluxation or dislocation. The most important task of surgery is to restore the anatomical position of the hip center of rotation.The study purpose — to evaluate the early results of hip arthroplasty with individual augments in the patients with hip dysplasia.Materials and Methods. Since 2017, nine patients with hip dysplasia have undergone surgery using individually printed augments. All patients were women with average age 51.3±14.5 years (23 to 67). The mean follow-up was 14.3±5.2 months (8 to 20). Patients were evaluated using follow-up X-rays, a visual analogue scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC).Results. There was no a single case of endoprosthesis dislocation, loosening of components, prosthetic infection or revision surgery in the analyzed group of patients. The planned sizes of the acetabular components were equal to the placed in 7 cases (77.8%). In two cases (22.2%), the acetabular components were 2 mm larger because the surgeon wanted a greater degree of press-fit fixation. The restoration of the anatomical position of the acetabular component was noted. Before the surgery, the femoral head was on average 22.7±11.7 mm (10 to 43 mm) higher. After the surgery, the level of the acetabular component was on average only 0.75±2.1 mm (1.7 to 5 mm), p = 0.008. Also, there were a decrease in pain and quality of life improvement by VAS from 6.78±1.39 before surgery to 2.22±1.09 at follow-up (p = 0.007), HHS increase from 30.5±18. 1 to 77.59±14.26 (p = 0.008), and WOMAC decrease from 73.3±14.1 to 18.22±8.2 (p = 0.008).Conclusion. The individually printed augments have shown high efficacy for restoration of the anatomical center of rotation and good early results in the patients with hip dysplasia undergone hip arthroplasty.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

Sign in / Sign up

Export Citation Format

Share Document