scholarly journals Synthetic Bone Grafting in Aseptic Loosening of Acetabular Cup: Good Clinical and Radiological Outcomes in Contained Bone Defects at Medium-Term Follow Up

2020 ◽  
Vol 17 (15) ◽  
pp. 5624
Author(s):  
Paolo Domenico Parchi ◽  
Matteo Simonetti ◽  
Enrico Bonicoli ◽  
Nicola Piolanti ◽  
Michelangelo Scaglione
Keyword(s):  
Revision Surgery ◽  
Disease Transmission ◽  
Bone Grafting ◽  
Bone Substitute ◽  
Porous Ceramic ◽  
Acetabular Cup ◽  
Hip Revision ◽  
Radiolucent Lines ◽  
Hip Revision Surgery

Restoring bone loss is one of the major challenges when facing hip revision surgery. To eliminate the risk of disease transmission and antigenicity of allografts and donor-morbidity of autografts, the use of synthetic bioceramics has become popular in the last decade. Our study investigated the effectiveness of impaction bone grafting (IBG) of contained acetabular defects (Paprosky 2 and 3a) using a porous ceramic-based hydroxyapatite bone substitute (Engipore, provided by Finceramica Faenza S.p.A., Faenza, Italy) mixed with a low percentage of autologous bone (obtained from reaming when available). We retrospectively assessed 36 patients who underwent acetabular revision using IBG using a porous ceramic-based hydroxyapatite bone substitute with cementless implants with a mean follow-up of 4.4 years. We evaluated, at regular intervals, patients clinically (using the Hip Harris Score and Oxford Score) and radiologically to evaluate the rate of incorporation of the graft, the presence of radiolucent lines or migrations of the cup. Clinical scores significantly improved (WOMAC improved from 49.7–67.30, and the HSS from 56–89). The rate of implants’ survival was 100% at our medium follow-up (4.4 years). We reported five cases of minor migration of the cup, and radiolucent lines were visible in seven patients at the last-follow up. The graft was well-incorporated in all patients. The results presented in this study suggest the HA bone substitute is an effective and safe bone graft when facing hip revision surgery; thus, longer follow-up studies are required.

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.

Corrosion at the Head-Neck Taper Interface Affects the Prognosis of Hip Revision Surgery

2015 ◽  
pp. 26-33
Author(s):  
Emmanouil Liodakis ◽  
Alberto Carli ◽  
David Zukor ◽  
Olga Huk ◽  
John Antoniou
Keyword(s):  
Revision Surgery ◽  
Hip Revision ◽  
Hip Revision Surgery ◽  
Head Neck

Intraoperative frozen section histopathology for the diagnosis of periprosthetic joint infection in hip revision surgery: the influence of recent dislocation and/or periprosthetic fracture

2020 ◽  
pp. 112070002093399
Author(s):  
Lucas Luyckx ◽  
Jan F A Somers ◽  
Kristof Cokelaere ◽  
Stijn Deloose ◽  
Gaétan Delrue ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Predictive Value ◽  
Periprosthetic Fracture ◽  
Frozen Section ◽  
Joint Infection ◽  
Hip Revision ◽  
Intraoperative Frozen Section ◽  
Hip Revision Surgery ◽  
Group A ◽  
Group B

Aims: To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. Patients and methods: The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). Results: The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. Conclusions: Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

Impacted Morsellised Allograft and Cemented Cup in Acetabular Revision Surgery. A Five to Nine Year Follow-Up Study

2002 ◽  
Vol 12 (3) ◽  
pp. 281-288 ◽  
Author(s):  
E. Garcia-Cimbrelo ◽  
J. Cordero
Keyword(s):  
Revision Surgery ◽  
Acetabular Revision ◽  
Cumulative Probability ◽  
Acetabular Bone ◽  
Radiolucent Lines ◽  
Frequent Use ◽  
Acetabular Bone Defect ◽  
Metallic Mesh ◽  
Cemented Cup

Seventy cemented cups associated with impacted morsellised allograft in revision surgery in hips with an acetabular bone defect greater than 30% (Paprosky Grades 3A and 3B) were analyzed. The mean follow-up was 6.8 years. One hip showed cup migration and was re-revised; this represents a total cumulative probability of re-revision of the cup of 1.4 ± 2.8%. Radiolucent lines were uncommon: six cups showed radiolucent lines in DeLee and Charnley zone 1, five in zones 1 and 2, one in all three zones, while one hip showed migration. Although the frequent use of a metallic mesh makes graft remodeling difficult to evaluate, six hips showed minor and one major bone resorption. The midterm results with impacted allograft and cemented all-polyethylene cups are favourable in acetabular revision surgery.

scholarly journals Arthroscopic Hip Revision Surgery for Residual FAI: Surgical Outcomes

2013 ◽  
Vol 1 (4_suppl) ◽  
pp. 2325967113S0005
Author(s):  
Christopher M. Larson ◽  
Russell Giveans ◽  
Asheesh Bedi ◽  
Kathryn M. Samuelson ◽  
Rebecca M. Stone
Keyword(s):  
Revision Surgery ◽  
Surgical Outcomes ◽  
Hip Revision ◽  
Hip Revision Surgery
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