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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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Jara-García F, Diranzo-García J, Estrems-Díaz V, Sánchez-Losilla C, Fuentes-Real S, Hernández-Ferrando L. Trabecular titanium implants in complex acetabular revision surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:94-101. [PMID: 36174957 DOI: 10.1016/j.recot.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/07/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analyzed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilization of the implants), as well as the appearance of complications. RESULTS The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.
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Affiliation(s)
- F Jara-García
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - J Diranzo-García
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - V Estrems-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - C Sánchez-Losilla
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Fuentes-Real
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - L Hernández-Ferrando
- Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, España
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[Translated article] Trabecular titanium implants in complex acetabular revision surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T94-T101. [PMID: 36535342 DOI: 10.1016/j.recot.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analysed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilisation of the implants), as well as the appearance of complications. RESULTS The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.
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Treatment of Severe Acetabular Bone Loss Using a Tantalum Acetabular Shell and a Cemented Monoblock Dual Mobility Acetabular Cup. J Am Acad Orthop Surg 2022; 30:e301-e306. [PMID: 34928889 DOI: 10.5435/jaaos-d-21-00433] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/31/2021] [Indexed: 02/01/2023] Open
Abstract
As the number of revision total hip arthroplasty increases, innovative solutions to complex problems are needed to address challenges posed by these complex cases. Severe acetabular bone loss, including cases of pelvic discontinuity, is a notable challenge with few solutions. Hip instability after revision arthroplasty remains one of the leading causes of revision and patient morbidity. The use of pelvic distraction and a press-fit tantalum shell for chronic discontinuity and posterior column open reduction and internal fixation with acetabular revision for acute pelvic discontinuity have previously been described. Similarly, dual mobility articulations have demonstrated long-term success in minimizing instability after revision total hip arthroplasty with good long-term survivorship. Here, the authors present a surgical technique in the management of Paprosky types 2 and 3 acetabular defects often with pelvic discontinuity using a tantalum shell in combination with cemented dual mobility liner to increase the stability of the joint. Custom screw placement is facilitated with the use of a metal cutting burr, both on the back table and in situ. The dual mobility liner is cemented, thus allowing for independent positioning of the acetabular implant and bearing surface. This technique has been successfully used in 19 patients with encouraging short-term results.
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Horberg JV, Bailey JR, Kay K, Allan DG. Staged Total Hip Arthroplasty: A Novel Technique in Managing Native and Periprosthetic Acetabular Insufficiency. Arthroplast Today 2021; 9:78-82. [PMID: 34136608 PMCID: PMC8180963 DOI: 10.1016/j.artd.2021.04.014] [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: 01/14/2021] [Revised: 03/24/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background There is no consensus on how to best address acetabular insufficiency. Several described techniques have a high rate of loosening and most rely on fixation to intact innominate bones. They also require extensive exposure and expensive implants. We present a novel technique for acetabular insufficiency management including discontinuity and a series with mean 6.5-year follow-up. Material and Methods After exposure, a femoral neck osteotomy is made, or the femoral component is removed. Bone graft is reverse reamed into the defect, and a porous coated acetabular shell is implanted with screws for supplemental fixation. In 3-6 months, after defect healing, the femoral component is implanted. All staged total hip arthroplasties for pelvic discontinuity from 2010 to 2015 by a single provider with minimum 5-year follow-up were identified. Implant survivorship, Merle d’Aubinge, and visual analog scale scores as well as complications were recorded. Results Nine patients were identified with mean 80.8-month follow-up (62-129). Merle D’Aubinge scores improved from 5.6 (4-8) to 15.3 (14-18), and Visual analog scale scores improved from 7.2 (6-9) to 0.8 (0-2). All implants were retained, and all patients were ambulatory at the terminal follow-up. There were 2 greater trochanter fractures, one calcar fracture managed with cerclage, and one patient developed heterotopic ossification. Conclusion Staged total hip arthroplasty can be used to address pelvic discontinuity with excellent short- to mid-term outcomes. This technique allows for a more limited exposure and the use of primary hip implants. Fixation is by ingrowth and does not rely on intact pelvic architecture.
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Affiliation(s)
- John V Horberg
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.,Orthopaedic Center of Illinois, Springfield, IL, USA
| | - J Ross Bailey
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kathleen Kay
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - D Gordon Allan
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.,Orthopaedic Center of Illinois, Springfield, IL, USA
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Russell SP, O'Neill CJ, Fahey EJ, Guerin S, Gul R, Harty JA. Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow-Up. J Arthroplasty 2021; 36:1740-1745. [PMID: 33468343 DOI: 10.1016/j.arth.2020.12.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases. METHODS 38 patients underwent revision total hip arthroplasty at our institution from 2009 to 2014 where a TM augment was used for acetabular deficiency. Prospective radiographic and Patient-Reported Outcome Measures were recorded and analyzed to a mean of 7.3 years (range: 5.4 to 10.8). RESULTS No patient was excluded or lost to follow-up. Complications included 3 intraoperative fractures, 1 early infection requiring washout with implant retention, 1 early revision due to allograft resorption, and 6 patients who required late repeat revision surgery: 3 for late infection, 2 for aseptic loosening with augment fracture or dislocation, and 1 for recurrent dislocation. The estimated mean implant survivorship was 8.99 years. 93.5% of augments remaining were well osseointegrated while 97% of the acetabular shells were osseointegrated. Hip center of rotation was restored by a mean of 14 mm inferiorly without significant medialization. Short Form-12 (SF-12) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were significantly reduced postoperatively to a level comparable to the average individual. CONCLUSION This long-term study details our experience of TM augments for the most severe acetabular defects. For such cases, no excellent surgical solution exists; in comparison to alternative methods, we advocate that this technique is reasonably safe and effective.
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Affiliation(s)
- Shane P Russell
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cathleen J O'Neill
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoin J Fahey
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shane Guerin
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
| | - Rehan Gul
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
| | - James A Harty
- Dept. of Trauma and Orthopaedics, South Infirmary Victoria University Hospital, Cork, Ireland; University College Cork, Cork, Ireland
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Siegel MA, Patetta MJ, Chen JY, Barragan Echenique DM, Gonzalez MH. The use of a triflange salvage system for catastrophic pelvic osteolysis after failed total hip arthroplasty. J Orthop 2021; 25:16-22. [PMID: 33897135 DOI: 10.1016/j.jor.2021.03.018] [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] [Received: 02/02/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction The custom triflange acetabular implant (CTAI) has been described to address catastrophic pelvic osteolysis, but long-term outcome data is scarce. Methods Revision-free survivorship after revision THA with a CTAI was retrospectively reviewed in seven patients. Results Mean and median follow-up time were 7.39 (1.61-16.8) years and 7.50 years, respectively. Revision-free survivorship was 85.7% (6/7). One patient underwent revision for recurrent dislocations. All patients were able to ambulate at recent follow-up- 2/7 without assistance. Conclusions The CTAI is a viable option for patients with catastrophic pelvic osteolysis. There is a high complication rate, but the incidence of revision is low.
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Affiliation(s)
- Matthew A Siegel
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | - Michael J Patetta
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | - Jason Y Chen
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | | | - Mark H Gonzalez
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
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Szczepanski JR, Perriman DM, Smith PN. Surgical Treatment of Pelvic Discontinuity: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 7:e4. [PMID: 31503100 DOI: 10.2106/jbjs.rvw.18.00176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pelvic discontinuity is a rare condition that is treated with a range of implant constructs. However, surgical failure rates are high, and outcome data are inconsistent. It is therefore difficult to gain a clear picture of whether recently developed constructs (antiprotrusio cage [APC], cup-cage, custom triflange, and porous metal) provide better outcomes in terms of mechanical failure and complications in the short to long terms. This study investigated the failure and complication rates associated with cage constructs and porous metal technologies. METHODS A systematic review and meta-analysis were performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines to evaluate the studies showing pelvic discontinuity in revision total hip arthroplasty. Data retrieved included the intervention performed, length of follow-up, mechanical failure, and other complication rates (dislocation, infection, neurological, loosening, migration). Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) instrument. Pooled mechanical failure and complication rates were calculated using MetaXL 5.3. RESULTS None of the included 30 articles (n = 585 hips) were of high quality. The meta-analyses revealed a mechanical failure rate of 14% for all constructs combined. Custom triflange (5%) and cup-cage (7%) had the lowest mechanical failure rates compared with the commonly used APC (25%) and porous metal (12%). The overall other complication rate was 28%, with cup-cage lower at 21% compared with APC (34%) and custom triflange (28%). Long-term evidence investigating both interventions and porous metal technology is limited. CONCLUSIONS Mechanical failure rates for cup-cage and custom triflange were lowest. The other complication rate for cup-cage was lower than the pooled average. The study quality was limited, indicating a need for better studies and/or a registry. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jason R Szczepanski
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.,School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia
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Meynen A, Matthews H, Nauwelaers N, Claes P, Mulier M, Scheys L. Accurate reconstructions of pelvic defects and discontinuities using statistical shape models. Comput Methods Biomech Biomed Engin 2020; 23:1026-1033. [PMID: 32619099 DOI: 10.1080/10255842.2020.1784404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Treatment of large acetabular defects and discontinuities remains challenging and relies on the accurate restoration of the native anatomy of the patient. This study introduces and validates a statistical shape model for the reconstruction of acetabular discontinuities with severe bone loss through a two-sided Markov Chain Monte Carlo reconstruction method. The performance of the reconstruction algorithm was evaluated using leave-one-out cross-validation in three defect types with varying severity as well as severe defects with discontinuities. The two-sided reconstruction method was compared to a one-sided methodology. Although, reconstruction errors increased with defect size and this increase was most pronounced for pelvic discontinuities, the two-sided reconstruction method was able to reconstruct the native anatomy with higher accuracy than the one-sided reconstruction method. These findings can improve the preoperative planning and custom implant design in patients with large pelvic defects, both with and without discontinuities.
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Affiliation(s)
- Alexander Meynen
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Harold Matthews
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nele Nauwelaers
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Peter Claes
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Michiel Mulier
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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Malahias MA, Ma QL, Gu A, Ward SE, Alexiades MM, Sculco PK. Outcomes of Acetabular Reconstructions for the Management of Chronic Pelvic Discontinuity: A Systematic Review. J Arthroplasty 2020; 35:1145-1153.e2. [PMID: 31784362 DOI: 10.1016/j.arth.2019.10.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/11/2019] [Accepted: 10/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A number of articles have been published reporting on the clinical outcomes of various acetabular reconstructions for the management of chronic pelvic discontinuity (PD). However, no systematic review of the literature has been published to date comparing the outcome and complications of different approaches to reconstruction. METHODS The US National Library of Medicine (PubMed/MEDLINE) and EMBASE were queried for publications from January 1980 to January 2019 using keywords pertinent to total hip arthroplasty, PD, acetabular dissociation, clinical or functional outcomes, and revision total hip arthroplasty or postoperative complications. RESULTS Overall, 18 articles were included in this analysis (569 cases with chronic PD). The overall survival rate of the acetabular components used for the treatment of chronic PD was 84.7% (482 of 569 cases) at mid-term follow-up, whereas the most common reasons for revision were aseptic loosening (54 of 569 hips; 9.5%), dislocations (45 of 569 hips; 7.9%), periprosthetic joint infection (30 of 569 hips; 5.3%), and periprosthetic fractures (11 of 569 hips; 1.9%). Both pelvic distraction technique (combined with highly porous shells) and custom triflanges resulted in less than 5% failure rates (96.2% and 95.8%, respectively) at final follow-up. Also, highly effective in the treatment of PD were cup-cages and highly porous shells with and/or without augments with 92% survivorship free of revision for aseptic loosening for both reconstruction methods. Inferior outcomes were reported for conventional cementless shells combined with acetabular plates (72.7%) as well as ilioischial cages and reconstruction rings (66.7% and 60.6% survivorship, respectively). CONCLUSION The current literature contains moderate quality evidence in support of the use of custom triflange implants and pelvic distraction techniques for the treatment of chronic PD, with a less than 5% all-cause revision rate and low complication rates at mean mid-term follow-up. Cup-cages and highly porous shells with or without augments could also be considered for the treatment of PD because both resulted in greater than 90% survival rates. Finally, there is still no consensus regarding the impact of different types of acetabular reconstruction methods on optimizing the healing potential of PD, and further studies are required in this area to better understand the influence of PD healing on construct survivorship and functional outcomes with each reconstruction method.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Qian-Li Ma
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY; Department of Orthopedic Surgery, Fuzhou Second Hospital affiliated to Xiamen University, Fuzhou, Fujian, China
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Sarah E Ward
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael M Alexiades
- Department of Orthopaedics, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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11
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Fraile Suari A, Marqués López F, Cuenca Llavall M, Tey Pons M, León García A. Reconstruction for pelvic discontinuity and massive acetabular defects. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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12
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Wirtz DC, Jaenisch M, Osterhaus TA, Gathen M, Wimmer M, Randau TM, Schildberg FA, Rössler PP. Acetabular defects in revision hip arthroplasty: a therapy-oriented classification. Arch Orthop Trauma Surg 2020; 140:815-825. [PMID: 32100108 PMCID: PMC7244606 DOI: 10.1007/s00402-020-03379-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects. METHODS The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability. RESULTS We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78. CONCLUSION The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.
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Affiliation(s)
- Dieter Christian Wirtz
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Max Jaenisch
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Thiemo Antonius Osterhaus
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Martin Gathen
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Matthias Wimmer
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Thomas Martin Randau
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Frank Alexander Schildberg
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Philip Peter Rössler
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Germany, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
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Fraile Suari A, Marqués López F, Cuenca Llavall M, Tey Pons M, León García A. Reconstruction for pelvic discontinuity and massive acetabular defects. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:64-73. [PMID: 31543412 DOI: 10.1016/j.recot.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The acetabular reconstruction with massive acetabular defects and pelvic discontinuity is a complex surgery with important difficulties for the orthopaedic surgeon. The objective of this study is to show the short and midterm results of the acetabular revision with the Cup-Cage construct in a consecutive serie of cases. MATERIAL AND METHODS Retrospectively we reviewed 22 consecutive patients with massive acetabular defects (8 Paprosky IIIa and 9 IIIB); 5 pelvic discontinuities; 2 pelvic fractures during the implantation of primary artroplasty, and one pelvic pseudoarthrosis. All were reoperated with a trabecular metal acetabular component and a Cup-Cage. We did clinical and radiological follow-up to detect machanical failures and loosening of the implant. RESULTS With a middle follow-up of 45.06 months (12-73 months) we did not see any radiographic failure of the implant (component migration, osteolysis neither rupture of the implant or screws). The complications (13,63%) included one recurrent luxation, one infection and one recurrent subluxation. The Merle d'Aubigné-Postel score improved from 6.91 to 14.36 and the punctuation in the range of motion from 2.91 to 4.36 on average of the values preoperatively and postoperatively respectively and improvement in Harris Hip Score 30 (16-55) to 72 (40-90) in the latest follow up. CONCLUSION The acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.
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Affiliation(s)
- A Fraile Suari
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España.
| | - Fernando Marqués López
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - M Cuenca Llavall
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - M Tey Pons
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
| | - A León García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital del Mar i l'Esperança, Barcelona, España
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O'Neill CJ, Creedon SB, Brennan SA, O'Mahony FJ, Lynham RS, Guerin S, Gul R, Harty JA. Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects. J Arthroplasty 2018; 33:823-828. [PMID: 29217393 DOI: 10.1016/j.arth.2017.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/07/2017] [Accepted: 10/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trabecular Metal (TM) augments are one option when reconstructing bone loss during acetabular side revision surgery. METHODS We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a TM shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at the time of surgery was 68.2 years (range 48-84). The mean length of follow-up was 36 months (range 18-74). RESULTS The mean preoperative short form 12 health survey improved from 27.7 before operation to 30.1 at the time of final follow-up (P = .001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 53 preoperatively to a mean of 78.8 at final follow-up (P < .0001). There was evidence of radiographic loosening in 7 of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening. CONCLUSION The use of TM in complex acetabular reconstruction is associated with good outcome in the short to medium term.
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Affiliation(s)
- Cathleen J O'Neill
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Stephen B Creedon
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Stephen A Brennan
- Department of Orthopaedic Surgery, Bon Secours Hospital, Cork, Ireland
| | - Fiona J O'Mahony
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Rosanne S Lynham
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Shane Guerin
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Rehan Gul
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - James A Harty
- Department of Orthopaedic Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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15
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Kavalerskiy GM, Murylev VY, Rukin YA, Elizarov PM, Lychagin AV, Tselisheva EY. Three-Dimensional Models in Planning of Revision Hip Arthroplasty with Complex Acetabular Defects. Indian J Orthop 2018; 52:625-630. [PMID: 30532303 PMCID: PMC6241052 DOI: 10.4103/ortho.ijortho_556_16] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Careful preoperative planning in revision cases with complex acetabular defects is crucial for optimal surgery outcome. However, in many cases, computed tomography (CT) scans cannot give a clear understanding of the pelvic destruction. Three-dimensional (3D) models-based on CT data can help surgeon in planning of complex acetabular reconstruction. MATERIALS AND METHODS We used 3D plaster pelvic models in 17 revision cases. There were 5 patients with Paprosky II C acetabular defects, 2 patients with Paprosky IIIA defects, and 10 patients with Paprosky IIIB defects (3 patients among them with pelvic discontinuity). We used 3D printer and digital 3D models based on CT scan data for 3D models printing. In 3 cases with Paprosky IIIB defects, we implanted custom-made acetabular components with the porous coating, also printed on the 3D printer. RESULTS In 14 cases, we used trabecular metal (TM) augments with TM cups. In 100% of cases, number and type of planned and used augments were same. In 9 (64.3%) cases, size of planned and used cups was same. In other cases, the difference was not >2 mm. CONCLUSIONS Use of 3D plaster models for the revision hip arthroplasty planning with complex acetabular defects has shown high accuracy in the clear understanding of acetabular bone deficiency.
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Affiliation(s)
- Gennadiy M Kavalerskiy
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia
| | - Valeriy Y Murylev
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia
| | - Yaroslav A Rukin
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia,Address for correspondence: Prof. Yaroslav A Rukin, Rukin Y., Zelenaya str., 32-2-72, Balashikha, Moscow Region, Russia, 143902. E-mail:
| | - Pavel M Elizarov
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia
| | - Alexey V Lychagin
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia
| | - Evgeniya Y Tselisheva
- Department of Trauma, Orthopaedics and Disaster Surgery, Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow 119991, Russia
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16
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Baauw M, van Hooff ML, Spruit M. Current Construct Options for Revision of Large Acetabular Defects. JBJS Rev 2016; 4:01874474-201611000-00002. [DOI: 10.2106/jbjs.rvw.15.00119] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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17
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Pelvic discontinuity: modern techniques and outcomes for treating pelvic disassociation. Hip Int 2016; 25:368-74. [PMID: 26044526 DOI: 10.5301/hipint.5000270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 02/04/2023]
Abstract
Pelvic discontinuity is an uncommon condition that usually presents in the revision total hip arthroplasty population. However, its incidence will most likely increase due to the increasing number of primary and revision total hip arthroplasties (THA) done in recent years. Pelvic discontinuity (acetabular disassociation) is perhaps one of the more challenging cases for the hip arthroplasty surgeon to manage. Historically, the management of pelvic discontinuity has been wrought with many challenges. What follows is a review of the current techniques and outcomes for acetabular reconstruction in patients with acetabular disassociation including: porous metal components, internal fixation with acetabular reconstruction, acetabular distraction with jumbo cups, cup and cage construct, and the use of custom triflange.The complexity of pelvic discontinuity and with the myriad of options available to the hip arthroplasty surgeon to address this particular issue, preoperative planning becomes all the more essential.
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18
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Management of pelvic discontinuity in revision total hip arthroplasty: a review of the literature. Hip Int 2016; 25:120-6. [PMID: 25385048 DOI: 10.5301/hipint.5000201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2014] [Indexed: 02/04/2023]
Abstract
Pelvic discontinuity is a complex problem in revision total hip arthroplasty. Although rare, the incidence is likely to increase due to the ageing population and the increasing number of total hip arthroplasties being performed. The various surgical options available to solve this problem include plating, massive allografts, reconstruction rings, custom triflanged components and tantalum implants. However, the optimal solution remains controversial. None of the known methods completely solves the major obstacles associated with this problem, such as restoration of massive bone loss, implant failure in the short- and long-term and high complication rates. This review discusses the diagnosis, decision making, and treatment options of pelvic discontinuity in revision total hip arthroplasty.
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20
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Ahmad AQ, Schwarzkopf R. Clinical evaluation and surgical options in acetabular reconstruction: A literature review. J Orthop 2015; 12:S238-43. [PMID: 27047229 PMCID: PMC4796576 DOI: 10.1016/j.jor.2015.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/07/2015] [Indexed: 01/19/2023] Open
Abstract
The purpose of this paper is to review the clinical indications for acetabular reconstruction in patients with underlying peri-prosthetic segmental and cavitary defects, evaluate steps in pre-operative planning, and present the American Academy of Orthopaedic Surgeons (AAOS) and Paprosky classification systems to categorize acetabular defects. We also present a review of the current surgical techniques to reconstruct the acetabular socket which includes a cementless acetabular component with morselized bone, structural allograft, jumbo and oblong cups, reinforcement rings, bone cages, custom triflange acetabular constructs, and trabecular metal components.
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Affiliation(s)
- Asim Qamar Ahmad
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital For Joint Diseases, New York, NY, USA
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21
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Busch V. The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis. Acta Orthop 2015; 86:1-21. [PMID: 25898151 DOI: 10.3109/17453674.2015.1041354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Vincent Busch
- Sint Maartenskliniek Orthopaedic surgery P.O. Box 9011, 6500 GM Nijmegen The Netherlands
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22
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Additively manufactured porous tantalum implants. Acta Biomater 2015; 14:217-25. [PMID: 25500631 DOI: 10.1016/j.actbio.2014.12.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/25/2014] [Accepted: 12/04/2014] [Indexed: 12/27/2022]
Abstract
The medical device industry's interest in open porous, metallic biomaterials has increased in response to additive manufacturing techniques enabling the production of complex shapes that cannot be produced with conventional techniques. Tantalum is an important metal for medical devices because of its good biocompatibility. In this study selective laser melting technology was used for the first time to manufacture highly porous pure tantalum implants with fully interconnected open pores. The architecture of the porous structure in combination with the material properties of tantalum result in mechanical properties close to those of human bone and allow for bone ingrowth. The bone regeneration performance of the porous tantalum was evaluated in vivo using an orthotopic load-bearing bone defect model in the rat femur. After 12 weeks, substantial bone ingrowth, good quality of the regenerated bone and a strong, functional implant-bone interface connection were observed. Compared to identical porous Ti-6Al-4V structures, laser-melted tantalum shows excellent osteoconductive properties, has a higher normalized fatigue strength and allows for more plastic deformation due to its high ductility. It is therefore concluded that this is a first step towards a new generation of open porous tantalum implants manufactured using selective laser melting.
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23
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Pierce TP, Cherian JJ, Jauregui JJ, Elmallah RDK, Mont MA. Outcomes of post-operative periprosthetic acetabular fracture around total hip arthroplasty. Expert Rev Med Devices 2014; 12:307-15. [PMID: 25486883 DOI: 10.1586/17434440.2015.991313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Post-operative periprosthetic acetabular fractures are rare, but serious complication following total hip arthroplasty (THA). As the number of THA performed each year increases so will the expected number of periprosthetic fractures, thus making the treatment of these fractures an important topic for discussion. The purpose of this review is to analyze the recent evidence on risk factors, fracture classification schemes and treatment strategies that have been used for periprosthetic acetabular fractures around THA. The modified Paprosky classification is the most widely used and is a useful guide for management strategies. This classification system provides the guidelines for developing multiple treatment algorithms for decision making. Treatment options for surgical management include open reduction and internal fixation with plating, use of reconstruction cages, trabecular metal augments and bone grafting as needed. Treatment decisions are still an area of controversy and current research.
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Affiliation(s)
- Todd P Pierce
- Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA
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24
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Abolghasemian M, Tangsaraporn S, Drexler M, Barbuto R, Backstein D, Safir O, Kuzyk P, Gross A. The challenge of pelvic discontinuity. Bone Joint J 2014; 96-B:195-200. [DOI: 10.1302/0301-620x.96b2.31907] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of ilioischial cage reconstruction for pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer, Warsaw, Indiana) cup-cage technique in our institution, due to the unsatisfactory outcome of using a cage alone in this situation. We report the outcome of 26 pelvic discontinuities in 24 patients (20 women and four men, mean age 65 years (44 to 84)) treated by the cup-cage technique at a mean follow-up of 82 months (12 to 113) and compared them with a series of 19 pelvic discontinuities in 19 patients (18 women and one man, mean age 70 years (42 to 86)) treated with a cage at a mean follow-up of 69 months (1 to 170). The clinical and radiological outcomes as well as the survivorship of the groups were compared. In all, four of the cup-cage group (15%) and 13 (68%) of the cage group failed due to septic or aseptic loosening. The seven-year survivorship was 87.2% (95% confidence interval (CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84) for the cage-alone group (p = 0.009). There were four major complications in the cup-cage group and nine in the cage group. Radiological union of the discontinuity was found in all successful cases in the cup-cage group and three of the successful cage cases. Three hips in the cup-cage group developed early radiological migration of the components, which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating pelvic discontinuity in mid-term follow-up and is preferred to ilioischial cage reconstruction. If the continuity of the bone graft at the discontinuity site is not disrupted, early migration of the components does not necessarily result in failure. Cite this article: Bone Joint J 2014;96-B:195–200.
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Affiliation(s)
- M. Abolghasemian
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - S. Tangsaraporn
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - M. Drexler
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - R. Barbuto
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - D. Backstein
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - O. Safir
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - P. Kuzyk
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
| | - A. Gross
- Mount Sinai Hospital, 600
University Avenue, Suite 476A, Toronto, Ontario
M5G 1X5, Canada
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Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P. A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplasty 2012; 27:1057-63.e1. [PMID: 22397857 DOI: 10.1016/j.arth.2011.11.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 10/06/2011] [Accepted: 11/27/2011] [Indexed: 02/01/2023] Open
Abstract
Eighteen consecutive hips with pelvic discontinuity and associated periprosthetic bone deficiency were treated with bulk allografts and Burch-Schneider antiprotrusio cage. Clinical and radiographic follow-up was performed at an average of 13.5 (range, 10.5-16.6) years. Three cages required re-revision because of infection (1) and aseptic loosening (2). Average Harris hip score improved from 31.9 to 77.0 points (P < .001). A severe resorption of the bone graft occurred in 2 hips. The stability of the cage was detected in 13 cases. The cumulative survival rate at 16.6 years with acetabular revision for any reason, radiographic loosening, or unhealing of the discontinuity as the end point was 72.2%. The use of Burch-Schneider cage and bulk allografts is an effective technique for the treatment of pelvic discontinuity.
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Affiliation(s)
- Dario Regis
- Department of Orthopaedic Surgery, University School of Medicine, Verona, Italy
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