scholarly journals ELEVATION OF THE CENTER OF ROTATION WITH THE USE OF JUMBO CUPS IN REVISION TOTAL HIP ARTHROPLASTY – A RADIOGRAPHIC STUDY

2021 ◽  
Vol 27 (1) ◽  
pp. 3518-3522
Author(s):  
Maksim Zagorov ◽  
◽  
Kalin Mihov ◽  
Svetoslav Dobrilov ◽  
Gergana Nenova ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Leg Length ◽  
Acetabular Cup ◽  
Hip Revision ◽  
Total Hip ◽  
Rotation Center ◽  
Press Fit ◽  
Cementless Cup ◽  
Jumbo Cup

Background: Acetabular revision with extra-large (jumbo) cementless cups is an effective treatment for many cavitary and segmental peripheral bone defects. However, hip center elevation may occur with the use of a jumbo cup owing to the superior direction of reaming and the increased diameter of the component compared with the native acetabulum. Purposes: The primary goal of this study was to evaluate the radiographically observed hip center elevation with the use of jumbo cups in acetabular and total hip revision at our institution. Materials and methods: We retrospectively reviewed control radiographic images of 43 consecutive patients treated with acetabular and total hip revision arthroplasty with a press-fit cementless cup. The difference between the height of the rotation center of the acetabular cup and the height of the rotation center of the contralateral native hip relative to the inter teardrop line was radiographically measured. Results: The radiographically measured mean elevation of the rotation center of the jumbo cup was 8,75 mm, which yielded an average increase in the height of the rotation centre of 83,6. A mean vertical shift of the rotation center of 0,72 mm was estimated for every 1 mm increase in the size of the jumbo cup. Conclusions: Our results indicate that the use of jumbo cups in revision hip arthroplasty leads to elevation of the rotation center of the hip with an average of 9 mm. This could be considered by the surgeon in an attempt to restore leg length, stability and biomechanics of the prosthetic hip.

Double-Modular Hip Device Design Susceptible to Stress Corrosion Failure

2009 ◽  
Author(s):  
Sara A. Atwood ◽  
Eli W. Patten ◽  
Kevin J. Bozic ◽  
Lisa A. Pruitt ◽  
Michael D. Ries
Keyword(s):  
Femoral Head ◽  
Femoral Anteversion ◽  
Metal Alloy ◽  
Leg Length ◽  
Acetabular Cup ◽  
Corrosion Failure ◽  
Total Hip ◽  
Press Fit ◽  
Free Mobility ◽  
Hip Replacements

Total hip replacements restore pain-free mobility to approximately 200,000 patients in the U.S. each year [1]. A typical hip system comprises a metal alloy stem, a femoral head (ceramic or metal alloy), and a polyethylene acetabular cup fit into a metal alloy backing. A modular press-fit Morse taper is commonly used to attach the femoral head to the stem. There are also more recent designs that incorporate a second interface at the neck-stem junction (Figure 1). Increased modularity in total hip replacement design allows the surgeon to intraoperatively preserve patient anatomy such as leg length and femoral anteversion and better balance the surrounding soft tissue for optimal biomechanics. However, modularity also increases the number of mechanical junctions and interfaces in the device which may lead to complications such as corrosion, wear, and fracture.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

scholarly journals The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Emelie Kristoffersson ◽  
Volker Otten ◽  
Sead Crnalic
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Developmental Dysplasia ◽  
Leg Length ◽  
Acetabular Cup ◽  
Digital Templating ◽  
Total Hip ◽  
Implant Size ◽  
Crowe Classification

Abstract Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.

Experimental and Finite Element Investigation of Cementless Cup/Bone Interface After Total Hip Arthroplasty

2004 ◽  
Author(s):  
Ivan Zivkovic ◽  
Farid Amirouche ◽  
Francisco Romero ◽  
Mark Gonzalez
Keyword(s):  
Finite Element ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Ingrowth ◽  
Element Model ◽  
Loading Conditions ◽  
Acetabular Cup ◽  
Bone Interface ◽  
Total Hip ◽  
Cementless Cup

Permanent fixation of a cementless total hip arthroplasty requires bone ingrowth into the femoral and acetabular components. Early micromotion at the acetabular cup/bone interface can preclude ingrowth threatening long term fixation. To better characterize micromotion of the interface under loading conditions, an experimental and finite element (FE) study was undertaken. In this study cadaver hemi-pelvises were implanted with cementless acetabular cups and subjected to cyclical axial load and torque. Detailed finite element model, validated with experimental results, was developed to further analyze the conditions affecting the initial stability and loosening of the interface for different loading conditions.

scholarly journals Reverse augmentation technique in hip revision arthroplasty: a new strategy for the management of acetabular reconstruction

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Christian Götze ◽  
Christian-Dominik Peterlein
Keyword(s):  
Revision Arthroplasty ◽  
Technical Note ◽  
Polyethylene Liner ◽  
Acetabular Reconstruction ◽  
Outer Diameter ◽  
Acetabular Defect ◽  
Hip Revision ◽  
Center Of Rotation ◽  
Total Hip ◽  
Rotation Center

Abstract Background The principle of acetabular total hip revision (THR) is based on acetabular reconstruction and restoration of the center of rotation. The use of augmentation in high cranial acetabular defects combined with a cementless revision shell was studied sufficiently. This study aimed to report a case with the use of an augment inside a cementless revision shell as a reverse augmentation technique. Methods We describe the case of an 86-year-old female patient with a massive acetabular defect during second revision for total hip arthroplasty (THA). Two problems occurred: (1) a fixed cemented stem with a nonmodular head size of 33 mm and (2) a high acetabular defect with an elevated rotation center. Results With the distraction technique, allograft filling was used to reconstruct the acetabular defect. A cementless revision shell (REDAPT, Smith and Nephew) with a size of 78 mm was used to stabilize the defect. Locking screws placed cranially and distally were used to stabilize the cup for secondary osseointegration. An augment was placed inside the cup to reconstruct the rotation center. A customized polyethylene liner (outer diameter, 54 mm/inner diameter, 33 mm) was positioned below the augment in the revision cup to reconstruct the center of rotation. An 18-month postoperative X-ray analysis showed a stable construct with full secondary osseointegration. Conclusion This is the first report of an augment used for a reverse technique inside a cementless shell to restore the center of rotation with the use of a customized polyethylene liner. This might be a reliable option for reconstruction of the center of rotation in large cementless revision cups in acetabular Paprosky type III defects. This technical note shows the possibility of using an augment as a reverse technique in a cementless revision cup.

scholarly journals The short-term outcome of hip revision arthroplasty with Trabecular Metal™ components and augments

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
L Noconjo ◽  
MB Nortje
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Trabecular Metal ◽  
Short Term ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Hip Revision ◽  
Total Hip

ABSTRACT BACKGROUND: Highly porous Trabecular Metal™ acetabular components are increasingly being used in revision hip arthroplasty as they facilitate ingrowth, provide a useful mechanism to deal with bone loss and may decrease the risk of infection. The purpose of this audit was to describe: 1) the total number of hip arthroplasty surgeries over Ave years, the ratio of revision to primary hip arthroplasty and indications for revision; 2) the short-term outcomes of revision hip arthroplasty with Trabecular Metal™ components and augments METHODS: A retrospective folder and radiograph review of all patients who had revision total hip arthroplasty (THA) at a tertiary level hospital from February 2012 to February 2017 was done RESULTS: There were 979 THAs performed over the period - 863 (87%) primary THAs, and 116 (12%) hip revision cases performed in 107 patients. Of the 116 (107 patients) hip revisions, there were seven (6%) re-revisions in Ave patients. The indications for revision were aseptic loosening 67 (59%), septic loosening 11 (10%), liner wear 18 (16%), periprosthetic fracture Ave (4%), other 15 (13%). Trabecular Metal™ was used for revision in 16 hips (14 patients), which is 14% of the total 116 revisions. There were ten females and four males with an average age of 61 years. The average duration of follow-up in this group was 18.5 months (1.5-39.2). In these 16 Trabecular Metal™ hips, there were three (19%) early failures of fixation due to technical errors CONCLUSION: In our institution, 12% of the arthroplasty is revision surgery. The indications for revision are similar to published literature. Trabecular Metal™ revisions had a 19% early failure rate due to technical error Level of evidence: Level 4 Keywords: Trabecular Metal™, augments, total hip arthroplasty, revision hip arthroplasty

scholarly journals More than a feeling?—Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

2022 ◽  
Author(s):  
Matthias Luger ◽  
Christian Stadler ◽  
Rainer Hochgatterer ◽  
Jakob Allerstorfer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Digital Templating ◽  
Stem Size ◽  
Total Hip ◽  
Press Fit ◽  
A Minor ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. Patients and methods We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. Results Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). Conclusion Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

scholarly journals Is Restoration of Hip Center Mandatory for Total Hip Arthroplasty of Protrusio Acetabuli?

2021 ◽  
Author(s):  
Beom Seok Lee ◽  
Hong Seok Kim ◽  
Jung Wee Park ◽  
O Sang Kwon ◽  
Young-Kyun Lee ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Implant Stability ◽  
Acetabular Cup ◽  
Total Hip ◽  
Protrusio Acetabuli ◽  
Press Fit ◽  
Initial Fixation

Abstract Background: While initial fixation by a press-fit of the acetabular cup is essential for the durability of the component, restoration of the hip center has been known as an attributable factor for implant survival and successful outcome. In protrusio acetabuli (PA), it might be difficult to obtain both restoration of the hip center and the press-fit of the acetabular cup simultaneously during total hip arthroplasty (THA). We tested a hypothesis that medialized cup, if press-fitted, does not compromise the implant stability and outcome after cementless THA of PA. Methods: We reviewed 27 cementless THAs of 23 patients with PA. During THA, we prioritized press-fit of the cup than the hip center restoration. A press-fit was obtained in 24 hips. In the remaining 3 hips, a press-fit could not be obtained, and reinforcement acetabular components were used. The hip center was restored in 18 cups; 15 primary cups and 3 reinforcement components, while it was medialized in 9 cups. We compared implant stability and modified Harris hip score (mHHS) between the 2 groups at a mean of 5.2 (2-16) year follow-up. Results: One restored reinforcement cup was loose. The remaining 26 cups; 17 restored cups and 9 medialized press-fitted cups, remained stable. The final mHHS was similar between the restored group and the medialized group (81.8 ± 10.8 vs 83.6 ± 12.1, p = 0.498). Conclusions: Press-fitted cups, irrespective of hip center restoration, rendered implant stability and favorable results. Initial fixation of the cup is more important than the restoration of hip center.

scholarly journals High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing?

2021 ◽  
Author(s):  
Matthias Luger ◽  
Julian Stiftinger ◽  
Jakob Allerstorfer ◽  
Rainer Hochgatterer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Total Hip ◽  
Press Fit ◽  
Group A ◽  
Leg Length Difference ◽  
Group B ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. Methods We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). Results Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). Conclusion High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.

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