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Li Z, Luo Y, Lu M, Wang Y, Gong T, Hu X, He X, Zhou Y, Min L, Tu C. 3D-printed Personalized Porous Acetabular Component to Reconstruct Extensive Acetabular Bone Defects in Primary Hip Arthroplasty. Orthop Surg 2024; 16:1642-1647. [PMID: 38837297 PMCID: PMC11216820 DOI: 10.1111/os.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Management of extensive acetabular bone defects in total hip arthroplasty (THA) remains challenging. This study aims to investigate the feasibility and preliminary outcomes of 3D-printed personalized porous acetabular components for the reconstruction of acetabular defects in primary THA. METHODS This retrospective study involved seven patients who received 3D-printed acetabular components in primary THA between July 2018 and March 2021. Preoperatively, acetabular bone defects were evaluated by referencing the Paprosky classification. There were two "Paprosky type IIIA" defects and five "Paprosky type IIIB" defects. The acetabular components were custom-made for each patient to reconstruct the extensive acetabular defects. The hip function was assessed according to the Harris hip score (HHS). Clinical and radiographic outcomes were assessed. RESULTS The average follow-up period was 40 months, ranging from 26 to 57 months. There were no patients lost to follow-up. The HHS improved from 44 (range: 33-53) before the operation to 88 (range: 79-93) at the final follow-up. Postoperative X-rays showed that the 3D-printed personalized components were properly fitted with the acetabulum. The average center of rotation (COR) discrepancy was 2.3 mm horizontally and 2.1 mm vertically, respectively. Tomosynthesis-Shimadzu metal artifact reduction technology images showed that the implant was in close contact with the host bone. Moreover, no complications were observed during the follow-up period, including loosening, dislocation, or component protrusion. CONCLUSION The implantation of 3D-printed personalized acetabular components showed accurate reconstruction, stable mechanical support, and favorable function at short-term follow-up. This may be a viable alternative method for reconstructing extensive acetabular defects in THA.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yi Luo
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Minxun Lu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yitian Wang
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Taojun Gong
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xin Hu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xuanhong He
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yong Zhou
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Li Min
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Chongqi Tu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
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Ganz R, Ulrich G, Kamineni S. Reinforcement Ring-Augmented Hip Arthroplasty: A 35-Year Follow-up. Arthroplast Today 2023; 24:101248. [PMID: 37964918 PMCID: PMC10641149 DOI: 10.1016/j.artd.2023.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 11/16/2023] Open
Abstract
During the late 1980s, techniques were evolving to prevent acetabular component loosening. Inadequate acetabular bone stock further complicated this concern, which was traditionally addressed with cementation and bone grafting during this time period. However, one evolving tactic to address acetabular component loosening in the setting of inadequate acetabular bone stock was to augment bone graft with an acetabular reinforcement ring. In 1963, a 26-year-old, active male sustained a right-sided femoral neck fracture following a skiing accident. He ultimately developed a collapsed femoral head and varus deformity of the femoral neck requiring a total hip arthroplasty with a cemented monoblock femoral component and a polyethylene acetabular component cemented into a reinforcement ring. The initial procedure was performed in 1988, and this prosthesis is still functioning 35 years later and represents one of the longest follow-ups of a patient with a primary total hip arthroplasty with a reinforcement ring.
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Affiliation(s)
- Reinhold Ganz
- Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | - Gary Ulrich
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Srinath Kamineni
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
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Wood MJ, Al-Jabri T, Zaghloul A, Lanting B, Giannoudis PV, Hart AJ. Periprosthetic acetabular fractures as a complication of total hip arthroplasty. Injury 2023; 54:111058. [PMID: 37748235 DOI: 10.1016/j.injury.2023.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ahmed Zaghloul
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alister James Hart
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, HA7 4LP, United Kingdom
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Kim HS, Kim JW, Chang JS, Kim CH. Revision Total Hip Arthroplasty Utilizing an Acetabular Reinforcement Ring with a Metal Augment: A Minimum Eight-Year Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1036. [PMID: 37374240 DOI: 10.3390/medicina59061036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An acetabular reinforcement ring (ARR) with a structural allograft is conventionally used to treat large acetabular bone defects or discontinuity during revision hip arthroplasty. However, ARR is prone to failure due to bone resorption and lack of incorporation. Here, we investigated the surgical outcomes of the patients who underwent revision total hip arthroplasty (THA) using ARR combined with a metal augment (MA). Materials and Methods: We retrospectively reviewed data from 10 consecutive patients who had a minimum 8-year follow-up after revision hip arthroplasty using ARR with MA in Paprosky type III acetabular defect. We collected patient demographics, surgical details, clinical scores (including Harris Hip Score (HHS)), postoperative complications, and 8-year survival rates. Results: Six male and four female patients were included. The mean age was 64.3 years, and the mean follow-up duration was 104.3 months (96.0-112.0 months). Trauma-related diagnosis was the most common reason for index surgery. Three patients underwent all component revision, and seven underwent cup revision. Six were confirmed as Paprosky type IIIA and four as type IIIB. The mean HHS at the final follow-up was 81.5 (72-91). One patient was diagnosed with prosthetic joint infection at the 3-month follow-up; therefore, the minimum 8-year survival rate with our technique was 90.0% (95% confidence interval, 90.3-118.5%). Conclusions: The satisfactory mid- to long-term results of revision THA suggest that ARR combined with tantalum MA is a viable revision option for treating severe acetabular defects with pelvic discontinuity.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Murylev V, Muzychenkov A, Elizarov P, Kukovenko G, Alekseev S, Zhuchkov AG, Erokhin NE. Long-term functional results of revision hip replacement using Burch-Schneider cages. J Orthop 2023; 37:53-58. [PMID: 36974092 PMCID: PMC10039112 DOI: 10.1016/j.jor.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results. Methods Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B. Results Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3. Conclusions The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.
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Affiliation(s)
- Valeriy Murylev
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexey Muzychenkov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Pavel Elizarov
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Grigoriy Kukovenko
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Semyon Alekseev
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Alexander G. Zhuchkov
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
| | - Nicolay E. Erokhin
- I.M.Sechenov First Moscow State Medical University (Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation
- S. P. Botkin Moscow City Clinical Hospital, Moscow City Arthroplasty Center, Moscow, 125284, Russian Federation
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Assi C, Mansour J, Boulos K, Caton J, Samaha C, El-Kayyem E, Yammine K. Major acetabular defects: outcomes of first revision total hip arthroplasty using Kerboull cross-plate with allograft and cemented dual mobility cup at a maximum follow-up of fourteen years. INTERNATIONAL ORTHOPAEDICS 2022; 46:2539-2546. [PMID: 36038654 DOI: 10.1007/s00264-022-05556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The use of dual mobility cups (DMC) has been shown to reduce hip instability after revision surgery. For severe acetabular bone loss, reconstruction with a Kerboull cross-plate and bone allograft would contribute to restoring native hip position and bone stock. Only two papers reported on the combination of Kerboull cross-plate with bone allograft and cemented DMC in revision total hip arthroplasty (THA). METHODS This is a monocentric retrospective study (28 cases) of first-time revision THA using such a construct in American Association of Orthopaedic Surgeons (AAOS) grade III and IV acetabular bone defect. Detailed demographic, clinical and radiographic results were recorded and evaluated. RESULTS With a mean follow-up of six ± 3.63 years, no case of instability was reported. The modified Harris Hip Score (mHHS) was 88.4 ± 10.1. No hook fracture or mechanical failure was observed. Non-progressive radiolucent lines were recorded. Osteointegration of the allografts was observed in all cases with a mean Grodet score of 7.9 ± 0.97. CONCLUSIONS In first revision THA, the use of a Kerboull cross-plate with allograft and a cemented DMC in AAOS grade III and IV acetabular bone defects demonstrated excellent clinical and radiological outcomes with no recorded cases of dislocation or mechanical failure.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
- Center of Evidence-Based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Karl Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | | | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Elie El-Kayyem
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon.
- Institut de Chirurgie Orthopédique, Lyon, France.
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Ivanova S, Vuillemin N, Hapa O, Siebenrock KA, Keel MJB, Tosounidis TH, Bastian JD. Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091254. [PMID: 36143931 PMCID: PMC9503264 DOI: 10.3390/medicina58091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60−86)) that underwent a revision THA within 24 ± 17 days (5−60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5−5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively.
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Affiliation(s)
- Silviya Ivanova
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Vuillemin
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Dokuz Eylül University, Izmir 35330, Turkey
| | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Marius J. B. Keel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theodoros H. Tosounidis
- Department of Orthopaedic Surgery, Medical School, University of Crete, University Hospital, 71003 Heraklion, Crete, Greece
| | - Johannes D. Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Malahias MA, Sarantis M, Gkiatas I, Jang SJ, Gu A, Thorey F, Alexiades MM, Nikolaou VS. The modern Burch-Schneider antiprotrusio cage for the treatment of acetabular defects: is it still an option? A systematic review. Hip Int 2022:11207000221099817. [PMID: 35658595 DOI: 10.1177/11207000221099817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A number of papers have been published about the clinical performance of modern rough-blasted titanium Burch-Schneider antiprotrusio cages (BS-APCs) for the treatment of acetabular bone defects. However, no systematic review of the literature has been published to date. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications using keywords pertinent to Burch-Schneider antiprotrusio cage, revision THA, and clinical outcomes. RESULTS 8 articles were found to be suitable for inclusion in the present study in which 374 cases (370 patients) had been treated with modern BS-APCs. Most acetabular bone defects were type 3 according to the Paprosky classification (type 2C: 18.1%, 3A: 51%, and 3B: 28.9%). The overall re-revision rate for the 374 acetabular reconstructions with modern BS-APCs was 11.5% (43 cases). The short-term survival rate of the modern BS-APC construct was 90.6% (339 out of 374 cases), while the mid-term survival rate was 85.6% (320 out of 374 cases), and the long-term survival rate 62% (54 out of 87 cases). The most common reasons for revision were aseptic loosening (5.6%), periprosthetic joint infection (3.8%), dislocation (2.7%), and acetabular periprosthetic fracture (1.9%). CONCLUSIONS There was moderate quality evidence to show that the use of modern rough blasted titanium BS-APCs in cases of acetabular bone loss has an unacceptably high failure rate (38%). Given that antiprotrusio cages do not provide any biological fixation, we would not recommend the routine use of modern BS-APCs in complex revision THA cases. By contrast, the satisfactory short- to mid-term outcome of modern BS-APCs in combination with their low cost compared to highly porous acetabular implants, make us feel that BS-APCs might still be used in selected elderly or low-demand patients without severe superomedial acetabular bone loss.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Seong J Jang
- Weill Cornell Medical College, New York, NY, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | | | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Ranzzi A, Lucena RDLD, Schwartsmann CR, Galia CR, Girotto MC, Spinelli LDF. Estudo comparativo com e sem o uso de prototipagem em 3D de uma técnica não convencional no planejamento cirúrgico de revisão de artroplastia total de quadril. Rev Bras Ortop 2021; 57:884-890. [PMID: 36226209 PMCID: PMC9550379 DOI: 10.1055/s-0041-1731659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/11/2021] [Indexed: 11/30/2022] Open
Abstract
This article presents a comparison between two cases in which there was a need for revision of total hip arthroplasty due to aseptic acetabular failure. We used 3D prototyping in one of the cases to perform an unconventional technique of molding synthesis material before the procedure to evaluate the time saved in the transoperative period in complex cases.
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Affiliation(s)
- Alonso Ranzzi
- Departamento de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Rafael de Luca de Lucena
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Serviço de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Carlos Roberto Schwartsmann
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Departamento de Clínica Cirúrgica, Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Carlos Roberto Galia
- Departamento de Cirurgia, Ortopedia e Traumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Marina Cornelli Girotto
- Serviço de Ortopedia e Traumatologia, Santa Casa de Misericórdia de Porto Alegre, Rio Grande do Sul, Brasil
- Serviço de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
| | - Leandro de Freitas Spinelli
- Departamento de Clínica Cirúrgica, Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Rio Grande do Sul, Brasil
- Programa de Pós-Graduação em Projeto e Processos de Fabricação, Laboratório de Bioengenharia, Biomecânica e Biomateriais, Universidade de Passo Fundo, Rio Grande do Sul, Brasil
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10
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Abstract
Pelvic discontinuity (PD) has been a considerable challenge for the hip revision arthroplasty surgeon. However, not all PDs are the same. Some occur during primary cup insertion, resembling a fresh periprosthetic fracture that separates the superior and inferior portions of the pelvis, while others are chronic as a result of gradual acetabular bone loss due to osteolysis and/or acetabular implant loosening. In the past, ORIF, various types of cages, bone grafts and bone cement were utilized with little success. Today, the biomechanics and biology of PD as well as new diagnostic tools and especially a variety of new implants and techniques are available to hip revision surgeons. Ultraporous cups and augments, cup-cage constructs and custom triflange components have revolutionized the treatment of PD when used in various combinations with ORIF and bone grafts. For chronic PD the cup-cage construct is the most popular method of reconstruction with good medium-term results. Dislocation continues to be the leading cause of failure in all situations, followed by infection. Ultimately, surgeons today have a big enough armamentarium to select the best treatment approach. Case individualization, personal experience and improvisation are the best assets to drive treatment decisions and strategies.
Cite this article: EFORT Open Rev 2021;6:459-471. DOI: 10.1302/2058-5241.6.210022
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Affiliation(s)
- George C Babis
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
| | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
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Ishikura H, Nakamura M, Matsuda K, Tanaka T, Kawano H, Tanaka S. Severe osteolysis and periprosthetic femoral fracture 45 years after acrylic hemiarthroplasty of the hip: a case report. BMC Musculoskelet Disord 2021; 22:482. [PMID: 34034743 PMCID: PMC8152131 DOI: 10.1186/s12891-021-04380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip arthroplasty using acrylic prosthesis was once conducted; however, it has now been abandoned because of early breakages and wear of material. Therefore, complications or revision surgeries due to the use of acrylic prostheses are becoming rare. CASE PRESENTATION A 76-year-old woman presented with a sudden onset of severe pain in her left femur while walking. Radiographs revealed severe osteolysis and periprosthetic femoral fracture 45 years after the initial hemiarthroplasty using an acrylic prosthesis. We performed a Girdlestone resection arthroplasty by removing the prosthesis and fixing the fracture site using an intramedullary nail and metal plate. The patient was pain-free in her hip and leg 2 years and 9 months after the surgery. Although she walked with a cane or crutches, no postoperative complications were observed. CONCLUSIONS The combined use of an intramedullary nail and plate fixation with resection arthroplasty could offer acceptable results for patients with severe osteolysis and periprosthetic fracture after femoral head replacement using an acrylic prosthesis. Our report seems relevant because it not only reminds us of the significant steps made in the development of modern total hip arthroplasty; it also highlights one of the surgical options for severe osteolysis and periprosthetic fracture of the hip.
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Affiliation(s)
- Hisatoshi Ishikura
- Department of Orthopaedic Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kenta Matsuda
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Burastero G, Cavagnaro L, Chiarlone F, Zanirato A, Mosconi L, Felli L, de Lorenzo FDR. Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects. INTERNATIONAL ORTHOPAEDICS 2020; 44:1957-1964. [PMID: 32542450 DOI: 10.1007/s00264-020-04623-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). Severe bone loss is not uncommon especially in periprosthetic joint infection. Surgical options, including revision shells, rings, and cages-with or without bone allograft-are affected by high complication rates and unsatisfactory clinical results. We report our mid-term results of non-flanged, custom-made acetabular components in staged rTHA. METHODS We retrospectively reviewed all patients undergoing two-stage revision with acetabular custom-made implants between 2014 and 2016 at a single institution. Harris Hip Scores, Oxford Hip Scores, and Visual Analogue Scales for pain were obtained, and radiographical follow-up was performed. Complications were reported and analysed. RESULTS We included 19 patients (19 hips) with an average follow-up of 42.3 ± 11.8 months. At the time of re-implantation, significant acetabular bone loss according to Paprosky classification (IIC, IIIA-B, and pelvic discontinuity) was detected in our patients. Clinical outcomes showed statistically significant improvement from pre-operative visit to last follow-up (p < 0.01). All custom-made implants had radiological osseointegration, and we did not find any implant complications, such as loosening or malposition. No mismatch between pre-operative planning and intra-operative findings was observed. To date, we report one septic failure managed with second staged revision, and one re-operation for recurrent THA dislocation. CONCLUSIONS Custom-made acetabular implants showed excellent clinical and radiographic mid-term outcomes with a low rate of related complications, providing implant stability on residual host bone, restoring hip biomechanics, and allowing biological osseointegration. Further long-term studies are needed to confirm preliminary results.
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Affiliation(s)
- Giorgio Burastero
- Ortopedia e Traumatologia II - Joint Replacement Unit/Bone Infection Unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Luca Cavagnaro
- Ortopedia e Traumatologia II - Joint Replacement Unit/Bone Infection Unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Francesco Chiarlone
- Ortopedia e Traumatologia II - Joint Replacement Unit/Bone Infection Unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Andrea Zanirato
- Ortopedia e Traumatologia II - Joint Replacement Unit/Bone Infection Unit, Santa Corona Hospital, Pietra Ligure (SV), Italy
| | - Lorenzo Mosconi
- Clinica Ortopedica - Policlinico San Martino, Genova (GE), Italy
| | - Lamberto Felli
- Clinica Ortopedica - Policlinico San Martino, Genova (GE), Italy
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13
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Stemmed acetabular cup as a salvage implant for revision total hip arthroplasty with Paprosky type IIIA and IIIB acetabular bone loss. Orthop Traumatol Surg Res 2020; 106:589-596. [PMID: 32265174 DOI: 10.1016/j.otsr.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Certain cases of repeated acetabular loosening with severe bone loss are hardly amenable to reconstruction using a Kerboull-type plate with allograft. This limitation is more likely when the severe bone loss occurs in older adults with significant comorbidities that may require a faster procedure. In these indications, a stemmed acetabular cup may be an alternative, although the outcomes have not been well defined, especially for a version where the peg is coated with porous material and additional screws can be added. This led us to conduct a retrospective study to determine: (1) whether a stemmed cup anchored in the iliac isthmus is a viable alternative in these situations, (2) the complication rate and (3) the revision rate for any reason. HYPOTHESIS A stemmed cup anchored in the iliac isthmus is a viable alternative in cases of repeated revision with severe acetabular bone loss. MATERIALS AND METHODS We performed a retrospective single-center study. Sixteen Integra™ cups were implanted in 14 patients (mean age 72.8±10.4 years, minimum-maximum: 58-95) who had aseptic acetabular loosening combined with severe acetabular bone loss graded as Paprosky IIIA in 7 hips and IIIB in 9 hips. The patients had undergone a mean of 2.7±1.8 (minimum-maximum: 1-6) procedures (i.e. primary and/or revision arthroplasty) before this cup was implanted. The cup's survivorship at the time of review and the complication rate were determined. RESULTS At a mean follow-up of 48.8±23.4 months (minimum-maximum: 7-85), two patients had died and two were lost to follow-up. Six hips experienced one or more complications (37.5%): three infections (18.8%), two mechanical failures (12.5%) and one dislocation (6.7%). The cup had to be removed in three patients (18.8%). These complications required reoperation, thus the cumulative incidence of revision for any reason at 5 years was 31% (95% CI: 11-55%). CONCLUSION Despite the high complication and revision rates, we believe the stemmed acetabular cup is a viable alternative in salvage reconstruction procedures. LEVEL OF EVIDENCE IV, Retrospective case study.
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Sayac G, Neri T, Schneider L, Philippot R, Farizon F, Boyer B. Low Revision Rates at More Than 10 Years for Dual-Mobility Cups Cemented Into Cages in Complex Revision Total Hip Arthroplasty. J Arthroplasty 2020; 35:513-519. [PMID: 31543421 DOI: 10.1016/j.arth.2019.08.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Instability and aseptic loosening are the two main complications after revision total hip arthroplasty (rTHA). Dual-mobility (DM) cups were shown to counteract implant instability during rTHA. To our knowledge, no study evaluated the 10-year outcomes of rTHA using DM cups, cemented into a metal reinforcement ring, in cases of severe acetabular bone loss. We hypothesized that using a DM cup cemented into a metal ring is a reliable technique for rTHA at 10 years, with few revisions for acetabular loosening and/or instability. METHODS This is a retrospective study of 77 rTHA cases with severe acetabular bone loss (Paprosky ≥ 2C) treated exclusively with a DM cup (NOVAE STICK; Serf, Décines-Charpieu, France) cemented into a cage (Kerboull cross, Burch-Schneider, or ARM rings). Clinical scores and radiological assessments were performed preoperatively and at the last follow-up. The main endpoints were revision surgery for aseptic loosening or recurring dislocation. RESULTS With a mean follow-up of 10.7 years [2.1-16.2], 3 patients were reoperated because of aseptic acetabular loosening (3.9%) at 9.6 years [7-12]. Seven patients (9.45%) dislocated their hip implant, only 1 suffered from chronic instability (1.3%). Cup survivorship was 96.1% at 10 years. No sign of progressive radiolucent lines were found and bone graft integration was satisfactory for 91% of the patients. CONCLUSION The use of a DM cup cemented into a metal ring during rTHA with complex acetabular bone loss was associated with low revision rates for either acetabular loosening or chronic instability at 10 years.
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Affiliation(s)
- Gary Sayac
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, Saint-Etienne, France
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, Saint-Etienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon, University Jean Monnet, Saint-Etienne, France
| | - Loïc Schneider
- Department of Orthopaedic Surgery, Clinique Mutualiste of Saint-Etienne, Saint-Etienne, France
| | - Rémi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, Saint-Etienne, France; EA 7424 - Inter-university Laboratory of Human Movement Science, University Lyon, University Jean Monnet, Saint-Etienne, France
| | - Frédéric Farizon
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, Saint-Etienne, France; INSERM U1059 (SAINBIOSE), University Jean Monnet, Saint-Etienne, France
| | - Bertrand Boyer
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, Saint-Etienne, France; INSERM U1059 (SAINBIOSE), University Jean Monnet, Saint-Etienne, France
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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