scholarly journals Theoretical Aspects, Modern Treatment Options and Practical Case Presentations in Hip and Knee Tumoral and Revision Bone Defect Reconstruction Surgery

2019 ◽  
Vol 69 (12) ◽  
pp. 3664-3668
Author(s):  
George Dinache ◽  
Marinel Drignei ◽  
Stergios Ganatsios ◽  
Eric Jovenet ◽  
Radu Costea ◽  
...  
Keyword(s):  
Bone Defect ◽  
Revision Surgery ◽  
Distal Femur ◽  
Treatment Options ◽  
Bone Defects ◽  
Practical Case ◽  
Acetabular Bone ◽  
Acetabular Bone Defects ◽  
Case Presentations ◽  
Bone Defect Reconstruction

Bone defects are a challenge to any and in fact every orthopedic surgeon, be they as a consequence of trauma, peri-implant bone loss as is the case in revision surgery or, more often than not, in tumors of the bone. These defects are in most cases difficult to reconstruct, but even more so in the case when they are located around the major joints of the lower limb, i.e. the hip and the knee. We focus in this article on acetabular bone defects as well as on defects around the knee (distal femur and proximal tibia). We present implant possibilities and modern means of reconstructing the bone defect using augments. We also present three representative cases from our Clinic, to further exemplify the discussed concepts. We present our opinions on reconstructing bone defects after tumor and revision surgery in the hip and knee and we draw conclusions.

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.

scholarly journals Bone defect map of the true acetabulum in hip dysplasia (Crowe type II and III) based on three-dimensional image reconstruction analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xinggui Wen ◽  
Jianlin Zuo ◽  
Tong Liu ◽  
Zhongli Gao ◽  
Jianlin Xiao
Keyword(s):  
Bone Defect ◽  
Three Dimensional ◽  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Type Ii ◽  
Acetabular Bone ◽  
Depth Study ◽  
Acetabular Bone Defects ◽  
Ct Data ◽  
Bone Coverage

AbstractThe high hip center technique (HHC) is considered to be feasible for acetabular reconstruction in patients with DDH, but there is little in-depth study of its specific impact on Crowe type II and III DDH. The purpose of this study was to simultaneously analyze the effect of HHC on bone coverage of the cup (CC) in the acetabular reconstruction of type II and III DDH patients and to propose a map of acetabular bone defects from the perspective of the cup. Forty-nine hip CT data of 39 patients with DDH (Crowe type II and III) were collected to simulate acetabular reconstruction by cup models of different sizes (diameter 38mm–50 mm, 2 mm increment) with the HHC technique. The frequency distribution was plotted by overlapping the portions of the 44 mm cups that were not covered by the host bone. The mean CC of cups with sizes of 38 mm, 40 mm, 42 mm, 44 mm, 46 mm, 48 mm, and 50 mm at the true acetabula were 77.85%, 76.71%, 75.73%, 74.56%, 73.68%, 72.51%, and 71.75%, respectively, and the maximum CC increments were 21.24%, 21.58%, 20.86%, 20.04%, 18.62%, 17.18%, and 15.42% (P < 0.001), respectively, after the cups were elevated from the true acetabula. The bone defect map shows that 95% of type II and III DDH acetabula had posterosuperior bone defects, and approximately 60% were located outside the force line of the hip joint. Acetabular cups can meet a CC of more than 70% at the true acetabulum, and approximately 60% of Crowe type II and III DDH patients can obtain satisfactory CC at the true acetabulum by using a 44-mm cup without additional operations.

scholarly journals Using Tantalum Augments for Major Acetabular Bone Defects in Revision Hip Surgery

2019 ◽  
Vol 2 (2) ◽  
pp. 64-68
Author(s):  
Adrian Cursaru ◽  
Bogdan Şerban ◽  
Alexandru George Lupu ◽  
Dan Anghelescu ◽  
Georgian Iacobescu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Functional Results ◽  
Bone Defects ◽  
Acetabular Bone ◽  
Rotation Center ◽  
Acetabular Bone Defects ◽  
Harris Score ◽  
Revision Hip Surgery ◽  
Hip Rotation

AbstractAim. The purpose of the study was to follow up the clinical and functional results of the patients with major acetabular bone defects in revision hip surgery.Materials and methods. The study was retrospective, over a period of six years (from January 2014 to January 2019), and included all the patients with hip replacement, with major acetabular bone defects, who needed Tantalum blocks substitution.11 patients were included in the study (8 men and 3 women). The average age was 71 years (between 64 and 78 years old). The average follow up period was 23 months (between 11 and 36 months). Paprosky radiological classification was used for the preoperatory evaluation of the bone defects. In 9 cases, the bone defect was of type 2B Paprosky and in 2 cases, of type 3A. Harris score was determined preoperatory and postoperatory for the appreciation of functional results.Results. 6 patients were underwent replacement for coxarthrosis secondary to dysplasia, 2 patients for coxarthrosis secondary to aseptic necrosis and 3 patients for primary coxarthrosis.The average time elapsed from the moment of primary arthroplasty to the need of revision surgery was on average of 13 years (between 7 and 16 years). The postoperatory radiological evaluation showed an improvement of the hip rotation center from an average postoperative vertical position of 3.1 cm (between 1.2 and 4.6 cm) at an average postoperatory position of 1.1 cm (between 0.5 and 2.3). The average result of Harris score postoperatively was 36 (between 39 and 96). During the follow up period, no early loosening, infection or prosthesis dislocation was registered. Conclusions. The Tantalum Augments used in major acetabular bone defects in revision surgery represent a good option, correcting the hip rotation center, thus considerably improving the functional score.

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

2015 ◽  
Vol 39 (10) ◽  
pp. 2023-2030 ◽  
Author(s):  
Yuanqing Mao ◽  
Chen Xu ◽  
Jiawei Xu ◽  
Huiwu Li ◽  
Fengxiang Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Defects ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Bone ◽  
Total Hip ◽  
Type Iii ◽  
Acetabular Bone Defects

Porous metal revision shells for management of contained acetabular bone defects at a mean follow-up of six years

2012 ◽  
Vol 94-B (2) ◽  
pp. 158-162 ◽  
Author(s):  
A. Sternheim ◽  
D. Backstein ◽  
P. R. T. Kuzyk ◽  
G. Goshua ◽  
Y. Berkovich ◽  
...  
Keyword(s):  
Porous Metal ◽  
Bone Defects ◽  
Acetabular Bone ◽  
Acetabular Bone Defects
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