Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

2018 ◽  
Vol 69 (8) ◽  
pp. 2217-2221
Author(s):  
Stefan Mogos ◽  
George Viscopoleanu ◽  
Monica Dascalu ◽  
Radu Orfanu
Keyword(s):  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Management Options ◽  
Acetabular Bone ◽  
Type Iiia ◽  
Acetabular Bone Defects ◽  
The Mean ◽  
Acetabular Defects

The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.

Major Acetabular Defects Treated with the Burch-Schneider Antiprotrusion Cage and Impaction Bone Allograft in a Large Series: A 5- to 7- Year Follow-up Study

2016 ◽  
Vol 26 (6) ◽  
pp. 585-590 ◽  
Author(s):  
Axel Marx ◽  
Alexander Beier ◽  
Anne Richter ◽  
Christoph H. Lohmann ◽  
Andreas M. Halder
Keyword(s):  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Allograft ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Hip Revision ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Introduction Major bone defects are the greatest challenge in hip revision arthroplasty. Methods In a prospective, consecutive nonrandomised study we followed up 74 patients with Type III (AAOS) acetabular bone defects who underwent revision hip arthroplasty with bone grafting and implantation of a Burch-Schneider anti-protrusion cage (APC). The patients were examined pre- and postoperatively according to a standardised clinical and radiological protocol. No patient was lost to follow-up. Results 9 patients died before follow-up. In 9 other patients the APC was revised within the follow-up period. In 4 of these patients the revision was necessary because of aseptic loosening. In the remaining 5 cases joint infection, recurrent dislocation and 1 trauma were the reasons for revision. 56 patients were included in the statistical analysis. In the follow-up group the mean Harris Hip Score increased from 39.9 preoperatively to 73.2. 85% of the patients assessed their operation result as good or excellent. Conclusions In a large consecutive series the Burch-Schneider anti-protrusion cage proved to be a valuable option in the treatment of major acetabular bone defects in hip revision surgery.

Trabecular Metal Augments for Treatment of Acetabular Defects: A Systematic Review

2021 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Fabio Mancino ◽  
Alex Gu ◽  
Ivan De Martino ◽  
Danilo Togninalli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aseptic Loosening ◽  
Revision Rate ◽  
Bone Defects ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Hemispherical Shell ◽  
Acetabular Bone Defects ◽  
Acetabular Defects

AbstractSevere acetabular bone defects during revision total hip arthroplasty are often treated with a hemispherical shell and highly porous modular metal augments. Several papers have been already published reporting on the clinical performance of trabecular metal (TM) augments combined with a hemispherical shell for the management of severe acetabular defects. However, no systematic review of the literature has been published to date. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications utilizing keywords pertinent to tantalum augments and TM (Zimmer Biomet, Warsaw, Indiana) augments, revision THA, clinical outcomes, and complications associated with these procedures. Fifteen articles were found to be suitable for inclusion in the present study, which included 769 revision cases where acetabular augments were used. The majority of acetabular bone defects were type 3 according to the Paprosky classification (type 2A in 58 cases, 7.2%; type 2B in 139 cases, 17.2%; type 2C in 72 cases, 8.9%; type 3A in 360 cases, 44.7%; and type 3B in 177 cases, 22.0%). The overall revision rate for the 769 acetabular revisions with augments was 5.7% (46 cases) at mean mid-term follow-up. The most common reasons for revision were dislocation (3.3%), periprosthetic joint infection (2.9%), and aseptic loosening (2.7%). TM augments combined with hemispherical shells were found to be effective in the treatment of moderate-to-severe acetabular bone defects with a 5% acetabular component revision rate at mean mid-term follow-up. The literature did not delineate whether pelvic discontinuity was associated with a higher risk of aseptic loosening after TM augment. Further studies are needed to clarify the impact of additional screw fixation on survival rates, and whether the type of augment (wedge augments, “flying buttress” augments, column augments), the configuration used, and the number of screws influence clinical and radiographic outcomes.

scholarly journals Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacek Gagala
Keyword(s):  
Bone Graft ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Bone Graft Substitute ◽  
Acetabular Bone ◽  
Total Hip ◽  
Acetabular Bone Defects ◽  
Bone Graft Substitutes ◽  
Hip Arthroplasties

Abstract Background Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. Methods Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. Results The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. Conclusion Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

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

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 Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Jerzy Białecki ◽  
Maciej Kogut ◽  
Sławomir Chaberek ◽  
Paweł Bartosz ◽  
Marcin Obrębski ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Two Stage ◽  
Retrospective Assessment ◽  
Severe Bone Loss ◽  
Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

scholarly journals Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

2021 ◽  
Author(s):  
FIRAT OZAN ◽  
Murat Kahraman ◽  
Ali Baktır ◽  
Kürşat Gençer
Keyword(s):  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Catastrophic Failure ◽  
Total Hip ◽  
Catastrophic Failures ◽  
Revision Tha ◽  
The Mean ◽  
Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 66-72 ◽  
Author(s):  
Mattia Loppini ◽  
Paolo Schiavi ◽  
Antonello Della Rocca ◽  
Francesco Traverso ◽  
Federico Della Rocca ◽  
...  
Keyword(s):  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Type Iii ◽  
Heterotopic Ossifications ◽  
Radiographic Outcomes ◽  
Acetabular Bone Defects

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

scholarly journals Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Szu-Yuan Chen ◽  
Chi-Chien Hu ◽  
Chun-Chieh Chen ◽  
Yu-Han Chang ◽  
Pang-Hsin Hsieh
Keyword(s):  
Hip Arthroplasty ◽  
Cox Regression ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
Two Stage ◽  
Eradication Of Infection ◽  
The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

Reconstruction of Paprosky type III Acetabular Defects by the Three-dimensional Printed Porous Augment: Techniques and Clinical Outcomes of 18 Consecutive Cases

2020 ◽  
Author(s):  
Jun Fu ◽  
Ming Ni ◽  
Xiang Li ◽  
Wei Chai ◽  
Libo Hao ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Three Dimensional ◽  
Acetabular Bone ◽  
Type Iii ◽  
Acetabular Bone Defect ◽  
3D Printed ◽  
The Mean ◽  
Acetabular Defects

Abstract Background and Purpose: A major challenge posed by primary and revision total hip arthroplasty (THA) is the management of severe acetabular bone defect. Previous surgical techniques have certain limitations in the anatomical reconstruction and accurate match of severe acetabular defects. Until now, reports are scanty on the clinical outcomes of acetabular reconstruction by the three-dimensional (3D) printed porous augments in bone defect patients. This study reported the clinical outcomes of reconstruction of Paprosky type III acetabular defects by 3D printed porous augments.Methods: 18 patients with Paprosky type III acetabular defects receiving reconstructive surgery by 3D printed porous augments were included in current study. Their data, including general information, intra-operative findings, imaging results, functional scores and complications were retrospectively analyzed.Results: The mean follow-up time lasted 33.3 ± 2.0 (24-56) months. The average limb-length discrepancy (LLD) was 31.7 ± 4.2 (3-59) mm preoperatively, 7.7 ± 1.4 (1-21) mm postoperatively (p<0.0001) and 7.5 ± 1.2 (0-18) mm at the latest follow-up. The mean vertical position of hip center of rotation (HCOR) from the inter teardrop line changed from preoperative 50.7 ± 3.9 (23.3-75.3) mm to postoperative 22.9 ± 1.9 (10.1-40.3) mm (p<0.0001), with the latest follow-up revealing an HCOR of 22.3 ± 1.7 (11.0-40.5) mm. Follow-up study showed that no hip had radiolucencies and radiological loosening of the acetabular components and augment. The average HHS improved from 40.3 ± 4.5 (10.5-71) before operation to 88.4 ± 1.9 (75-97) at the last follow-up (p<0.0001). Moreover, follow-up exhibited that no periprosthetic joint infection, hip dislocation, fracture and re-revision occurred. Conclusion: Surgical treatment of Paprosky type III acetabular defect with 3D printed porous augment was simple, achieved good match between porous augment and the defect bone surface and the acetabular component, ideally restored LLD and HCOR after operation, significantly improved HHS score and attained good early clinical outcomes. It is a promising personalized solution for patients with severe acetabular bone defect.

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