scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Postoperative Dislocation ◽  
Component Loosening ◽  
Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Postoperative Dislocation ◽  
Component Loosening ◽  
Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Long Term Prognosis ◽  
Postoperative Dislocation ◽  
Component Loosening

Abstract Background: The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods: This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum follow-up of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results: At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occurred. Conclusions: Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity, with encouraging results at early-term. However, ongoing follow-up is required to determine the long-term prognosis in patients receiving this technique.

scholarly journals Extended Ischiopubic Fixation Using Porous Metal Augments In Cementless Acetabular Reconstruction During Revision Total Hip Arthroplasty

2020 ◽  
Author(s):  
Yong Huang ◽  
Yixin Zhou ◽  
Hongyi Shao ◽  
Hao Tang ◽  
Dejin Yang ◽  
...  
Keyword(s):  
Primary Stability ◽  
Porous Metal ◽  
Clinical Results ◽  
Fracture Dislocation ◽  
Harris Hip Score ◽  
Acetabular Reconstruction ◽  
Horizontal Distance ◽  
Stable Fixation ◽  
Center Of Rotation

Abstract Background: As opposed to rim fixation, 3-point fixation provides sufficient primary stability for cememless cups in the presence of massive bony deficiency. While several methods, including doming augments or flying buttress augments, have been introduced to reconstruct superior supportive points, good methods to establish supportive ischiopubic points are currently lacking. The aims of this study were to introduce the definition, indication and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical and radiographic results and complications of hips revised with EIF.Methods: Patients who underwent revision THA utilizing the technique of EIF with porous metal augments secured in the ischium and/or pubis in a single institution from February 2015 to February 2020 were retrospectively reviewed. 25 patients were included based on the criteria of minimum 2-year follow-up. The median duration of follow-up was 48.06 months (interquartile range: 41.37-62.20 months). The patients’ clinical results were assessed using of the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis index and any complications including infection, intraoperative fracture, dislocation, postoperative nerve palsy, hematoma, wound complication and/or any subsequent reoperation(s) were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation and cup orientoration. Results: At the most recent follow-up, 20 (80%) patients rated their satisfaction level as “very satisfied”, 5 (20%) were “satisfied”. The median HHS score improved from 36.00 preoperatively to 81.00 (p＜0.001) while the median WOMAC index score decreased from 74.50 preoperatively to 16.50 at the latest follow-up (p＜0.001). No intraoperative or postoperative complications were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative center of rotation to the anatomic center of rotation improved from 13.62 mm and 8.68 mm preoperatively to 4.42 mm and 4.19 mm, at final follow-up (p<0.001), respectively.Conclusions: Early follow-up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation and restoration of the center of rotation.

scholarly journals The use of a non-biological, bridging, antiprotrusio cage in complex revision hip arthroplasty and periacetabular reconstructive oncologic surgery. Is still today a valid option?: A mid/long-term survival and complications’ analysis

2021 ◽  
Author(s):  
Matteo Innocenti ◽  
Francesco Muratori ◽  
Giacomo Mazzei ◽  
Davide Guido ◽  
Filippo Frenos ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Harris Hip Score ◽  
Acetabular Reconstruction ◽  
Reconstruction Method ◽  
Term Survival ◽  
Primary Tumors ◽  
Risk Of Death ◽  
Group B

Abstract Introduction Burch–Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages’ failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked. Materials and methods We evaluated 73 patients who received a B-SlAC from January 2008 to January 2018. Group A, 40 oncological cases (22 primary tumors; 18 metastases); Group B, 33 failed THAs. We compared both Kaplan–Meier estimates of risk of failure and complication with the cumulative incidence function, taking account the competing risk of death. Cox proportional hazards model was utilized to identify possible predictors of instability and infection. Harris hip score HHS was used to record clinical outcomes. Results Medium follow-up was 80 months (24–137). Average final HHS was 61 (28–92), with no differences within the two groups (p > 0.05). The probabilities of failure and complications were 57% and 26%, respectively, lower in the oncologic group than in the rTHA group (p =0 .176; risk 0.43) (p = 0.52; risk 0.74). Extended ileo-femoral approach and proximal femur replacement (p =0.02, risk ratio = 3.2; p = 0.04, rr = 2.1) were two significant independent predictors for dislocations, while belonging to group B (p = 0.04, rr = 2.6) was predictable for infections. Conclusion Burch–Schneider-like antiprotrusio cages are a classical non-biological acetabular reconstruction method that surgeons should bear in mind when facing gross periacetabular bone losses, independently of their cause. However, dislocation and infection rates are high. Whenever possible, we suggest preserving the proximal femur in revision THA, and to use a less-invasive postero-lateral approach to reduce dislocation rates in non-oncologic cases.

Retrieval and Radiographic Analysis of the Contour Antiprotrusio Cage

2017 ◽  
Vol 27 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Jonathan M. Vigdorchik ◽  
Richard S. Yoon ◽  
Susannah L. Gilbert ◽  
Joseph D. Lipman ◽  
Mathias P. Bostrom
Keyword(s):  
Average Length ◽  
Biomechanical Analysis ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Intact Group ◽  
Future Design ◽  
Severe Bone Loss ◽  
Macroscopic Findings ◽  
Centre Of Rotation ◽  
Methods Of Treatment

Introduction Acetabular reconstruction in the setting of severe bone loss or pelvic discontinuity remains a challenging problem. Multiple methods of treatment have been described including antiprotrusio cages (APCs). The objective of this study is to combine biomechanical analysis of retrieved APCs with radiographic and clinical data to determine which factors influence or predict APC failure. Methods 41 APCs were identified. Sequential radiographs were examined for cage and polyethylene cup abduction angles, change in centre of rotation, screw placement, progression of cage failure, and failure mechanism. Cages were manually examined for gross macroscopic findings, breakage, and the location of breakage. High-resolution microscopy was used for further analysis. Results 24 cages were included in the analysis. Mean age of patients was 64.5 years (range 43-85 years); average length of implantation was 42.5 months (range 3-108 months). Average cage abduction angles were 56°; abduction for the cemented polyethylene cup was 44°. 14 of 24 cages were broken; 10 were intact. Of the broken cages, 10/14 broke through a screw hole in the ischial flange or just superior to the ischial flange. In the intact group, 6/10 failed due to pullout of the ischial screws. Discussion All cages had superior and lateralised centres of rotation. The majority of cages failed due to breakage or pullout at the ischial flange. Pelvic discontinuity was a large risk factor for a broken cage. Future design and technique modifications may result in superior outcomes in these complex acetabular reconstructions.

scholarly journals Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Iori Takigami ◽  
Yoshiki Ito ◽  
Takashi Mizoguchi ◽  
Katsuji Shimizu
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Rare Complication ◽  
Acetabular Reconstruction ◽  
Fibular Graft ◽  
Intraoperative Complication ◽  
Pelvic Discontinuity ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA), typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

Total Hip Arthroplasty after Vascularized Fibular Grafting

2012 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Thomas P Vail ◽  
Apostolos Dimitroulias ◽  
Jeff Hodrick ◽  
Rusty Brand ◽  
Nicholas Viens ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Harris Hip Score ◽  
Control Group ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty ◽  
Significant Difference ◽  
Fibular Grafting

ABSTRACT Background Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure. Materials and methods We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings. Results The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS). Conclusion Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty. Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.

Hemiarthroplasty in the Treatment of Hallux Rigidus

2008 ◽  
Vol 29 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Charles Sorbie ◽  
Gerald Anthony Briden Saunders
Keyword(s):  
Perioperative Complications ◽  
Proximal Phalanx ◽  
Hallux Rigidus ◽  
Rating System ◽  
Steel Alloy ◽  
Joint Mobility ◽  
Aofas Score ◽  
Component Loosening ◽  
Small Hematoma ◽  
Cobalt Chrome

Background: Osteoarthritis of the first metatarsophalangeal (MTP) joint is a painful, disabling condition. It can interfere with the ability to run and even walk without pain. An implant of cobalt-chrome steel alloy to replace the base of the proximal phalanx is one solution. The purpose of this study is to review our results with one of these implants. Materials and Methods: A series of 23 cases of hemiarthroplasty for the treatment of hallux rigidus from June 2000 to October 2001 has been evaluated using the AOFAS rating system, and the results are presented. Results: The average preoperative AOFAS score was 57 (range, 39 to 80). The AOFAS score after hemiarthroplasty was 88 (range, 75 to 100) at last followup (34 to 72 months). There were no perioperative complications except for a small hematoma. Only one patient has required further surgery after 3 years for worsening of a preexisting tendency to hallux valgus. Conclusion: A hemiarthroplasty retained, in most cases, joint mobility, strength, and alignment while relieving pain. There was no evidence, at last followup, of component loosening or osteolysis.

scholarly journals Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

2019 ◽  
Author(s):  
Hao Tang ◽  
Yixin Zhou ◽  
Zhuyi Ma ◽  
Yong Huang ◽  
Shengjie Guo
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Fixation Group ◽  
Acetabular Defects ◽  
Type 3

Abstract Background: We proposed a new concept of “iliac extended fixation” in revision total hip arthroplasty (THA) as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. This study reports the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type 3 acetabular defects. Methods: Thirty two revision THA patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2016 in our hospital. Patients were assessed using the Harris Hip Score (HHS) and the Western Ontario and McMaster Universities Osteoarthritis Index score (WOMAC). In addition, radiographs were assessed and patient reported satisfaction was collected. Results: At an average follow-up of 40 months (range 25 – 64 months), the postoperative HHS and WOMAC scores were significantly improved at the last follow-up (p < 0.001). The postoperative horizontal and vertical locations of the COR were significantly improved from the preoperative measurements (p < 0.05). Two (6.3 %) patients were dissatisfied with the outcome. The extracavitary iliac extended fixation group had significantly more horizontal screws fixation (4.6 ± 25.7° vs 41.9 ± 37.8°, p < 0.001) and higher rate of osteointegration in zone 1A (91.7% vs 50.0%, p = 0.023) than the intracavitary iliac extended fixation group. Conclusions: Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects, with promising short-term clinical and radiographic outcome.

scholarly journals A Systematic Review and Meta-Analysis of the SuperPATH Approach in Hip Arthroplasty

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Yanzhi Ge ◽  
Zuxiang Chen ◽  
Qisong Chen ◽  
Yanbin Fu ◽  
Mengqiang Fan ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Postoperative Recovery ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Transfusion Rate ◽  
Invasive Approach ◽  
Dichotomous Variables

Objective. To compare the clinical and radiographic results of the supercapsular percutaneously assisted total hip (SuperPATH) approach and the conventional approach in hip arthroplasty. Design. Based on a prepublished protocol (PROSPERO: CRD42020177717), we searched PubMed, Embase, and Cochrane for relevant literatures up to January 30, 2021. The methodological qualities were assessed using the guidelines provided by the Cochrane Collaboration for Systematic Reviews. Randomized- or fixed-effect models were used to calculate the weighted mean difference (WMD) or odds ratio (OR), respectively, for continuous and dichotomous variables. Results. 6 articles were included in the study, and 526 patients were selected, which included 233 cases in the SuperPATH groups and 279 cases in the conventional groups, and 4 cases performed two surgeries in succession. The SuperPATH group demonstrated shorter incision length ( WMD = − 7.87 , 95% CI (−10.05, −5.69), P < 0.00001 ), decreased blood transfusion rate ( OR = 0.48 , 95% CI (0.25, 0.89), P = 0.02 ), decreased visual analogue scale (VAS) ( WMD = − 0.40 , 95% CI (−0.72, −0.08), P = 0.02 ), and higher Harris hip score (HHS) ( WMD = 1.98 , 95% CI (0.18, 3.77), P = 0.03 ) than the conventional group. However, there was no difference in VAS ( P = 0.14 ) and HHS ( P = 0.86 ) between the two groups 3 months later, nor in the acetabular abduction angle ( P = 0.32 ) in either group. Conclusions. SuperPATH, as a minimally invasive approach with its reduced tissue damage, quick postoperative recovery, and early rehabilitation, demonstrates the short-term advantages of hip arthroplasty. As the evidences in favor of the SuperPATH technique were limited in a small number of studies and short duration of follow-up, more research is required to further analyze its long-term effect.

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