scholarly journals Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss

2012 ◽  
Vol 83 (4) ◽  
pp. 347-352 ◽  
Author(s):  
W Steven Borland ◽  
Raj Bhattacharya ◽  
James P Holland ◽  
Nigel T Brewster
Keyword(s):  
Bone Loss ◽  
Bone Grafting ◽  
Trabecular Metal ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Loss

Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review

2020 ◽  
pp. 112070002097185
Author(s):  
Michael-Alexander Malahias ◽  
Fabio Mancino ◽  
Alex Gu ◽  
Marco Adriani ◽  
Ivan De Martino ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Grafting ◽  
Survival Rates ◽  
Bone Defects ◽  
Reoperation Rate ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Cochrane Database ◽  
Acetabular Bone Defects

Introduction: In conjunction with impaction bone grafting (IBG), metal meshes have been proposed to minimise defects of the medial and superolateral walls in order to convert combined complex uncontained segmental defects into contained cavitary defects to facilitate IBG. Methods: The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to March 2019 utilising keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting, clinical or functional outcomes, revision THA, or postoperative complications. Results: 7 articles were found to be suitable for inclusion in the present study. The mean modified Coleman methodology score for methodological deficiencies of the studies was 45.3 (range 38–59). Severe acetabular bone loss was present in 56% of cases having moderate bone loss in 18%, and mild in 26%. The all-cause reoperation rate was 7.4%, while the all-cause revision rate of the acetabular component was 6.2%. Conclusions: IBG with mesh is effective for selected patients with acetabular bone defects. Most patients with moderate bone loss as well as selected patients with large superolateral defects can be successfully treated with IBG combined with mesh. There is limited data to show that IBG with mesh might be associated with decreased survival rates in patients with severe lateral defects (Paprosky IIIA) combined with ischial or medial wall osteolysis who require combined medial and lateral meshes. In addition, patients with severe superomedial migration of the cup (Paprosky IIIB) should not be treated with IBG and mesh.

Do trabecular metal cups achieve better results when compared to hemispherical porous titanium cups in acetabular revision surgery?

2020 ◽  
pp. 112070002091994
Author(s):  
Ana Cruz-Pardos ◽  
Eduardo García-Rey ◽  
Ricardo Fernandez-Fernández ◽  
José Ortega-Chamarro
Keyword(s):  
Bone Loss ◽  
Aseptic Loosening ◽  
Revision Surgery ◽  
Porous Titanium ◽  
Acetabular Revision ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Kaplan Meier ◽  
Acetabular Bone Loss ◽  
Significant Difference

Background: Trabecular metal (TM) cups were introduced in order to achieve better ingrowth and stability of the cup in acetabular revision surgery. As their use has evolved over time, we have queried whether TM cups would improve results in terms of the rate of aseptic loosening when compared to historical uncemented porous titanium cups used in revision surgery for acetabular bone loss in Hospital La Paz (Madrid, Spain). Methods: We retrospectively reviewed 197 acetabular revisions performed between 1991 and 2015. Titanium cups were used in 81 cases and TM cups in 116. The mean follow-up was 8.1 years (range 1–15); 12.0 ± 7.8 for titanium group and 5.4 ± 3.1 for TM group. The most common reason for revision was aseptic loosening. A Kaplan-Meier analysis was used to determine the survival of the cup, with radiological failure and re-revision due to aseptic loosening as the endpoints. Cox multivariate regression analyses were performed to assess different risk factors for failure. Results: 1 TM cup and 1 titanium cup were re-revised due to aseptic loosening ( p = 0.61). Radiological cup loosening was observed in 4 TM cups and 2 titanium cups ( p = 1.0). At 6 years, the probability of not having radiological cup loosening was 97.4% (95% CI, 93.9–100) for the titanium cups and 95.1% for the TM cups (95% CI, 90.1–99.9) ( p = 0.59). Another 5 cups were re-revised due to dislocation. Hips with a greater Paprosky defect showed a higher risk of loosening ( p < 0.05, hazard risk (HR) 3.04; 95% CI, 0.97–9.54). Conclusions: This study shows there was no significant difference in re-revision due to aseptic loosening or radiological loosening between titanium and TM cups in revision surgery for acetabular bone loss. Both types of cups demonstrate excellent results with a low failure rate and minimal complications.

scholarly journals Massive acetabular bone loss: Limits of trabecular metal cages

2011 ◽  
Vol 45 (1) ◽  
pp. 78 ◽  
Author(s):  
Manuel Villanueva-Martínez ◽  
Antonio Ríos-Luna ◽  
Juán Diaz-Mauriño
Keyword(s):  
Bone Loss ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Acetabular Bone Loss

Impaction bone grafting in hip re-revision surgery

2021 ◽  
Vol 103-B (3) ◽  
pp. 492-499
Author(s):  
Eduardo Garcia-Rey ◽  
Laura Saldaña ◽  
Eduardo Garcia-Cimbrelo
Keyword(s):  
Aseptic Loosening ◽  
Acetabular Component ◽  
Revision Surgery ◽  
Bone Grafting ◽  
Bone Defects ◽  
Bone Stock ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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