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Brandt J, Scheiderbauer R, Wezenberg D, Schilcher J. Preoperative Three-Dimensional Planning Using Computed Tomography Improves Screw Placement in Patients Undergoing Acetabular Revision Surgery. Arthroplast Today 2024; 29:101431. [PMID: 39328880 PMCID: PMC11424765 DOI: 10.1016/j.artd.2024.101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 09/28/2024] Open
Abstract
Background Stable fixation of joint replacement implants is essential to achieve osseointegration in uncemented implants. In acetabular revisions, screws often need to be utilized in quadrants other than the historically so-called "safe" zones to attain sufficient stability. The primary aim of this study was to determine whether preoperative three-dimensional (3D) planning for acetabular revision surgery influences screw length, specifically in the superior pubic ramus (SPR). Methods Between March 2017 and December 2021, 20 patients underwent preoperative two-dimensional (2D) planning (2D group), and 30 patients underwent 3D planning following the implementation of a new 3D planning software into clinical practice in September 2019 (3D group). Two observers, blinded to the groups, measured the total screw length, screw penetration depth, and cup position on available postoperative computed tomography examinations. For statistical comparisons, the mean measurement from the 2 observers was used. Results The median total screw lengths in the SPR were 16 mm in the 2D group and 25 mm in the 3D group (P = .004) and 40.5 mm compared with 50.5 mm in the ilium (P = .019). Median screw penetration depths in the SPR were 0 mm in the 2D group and 1.25 mm in the 3D group (P = .049). Conclusion Longer screws were used in the SPR and ilium when preoperative 3D planning was conducted. Due to the study design, we were not able to evaluate whether longer screws lead to better fixation. Further studies are needed to elucidate this question.
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Affiliation(s)
- Jonathan Brandt
- Department of Orthopaedic Surgery, Capio Specialistvård Motala, Motala, Sweden
- Department of Orthopaedic Surgery and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | | | - Daphne Wezenberg
- Department of Orthopaedic Surgery and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Jörg Schilcher
- Department of Orthopaedic Surgery and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Blackburn AZ, Mittal A, Velasco B, Baker C, Vandal NA, Tarabichi S, Humphrey TJ, Salimy MS, Courtney PM, Sheth NP, Bedair HS, Melnic CM. AAHKS Surgical Techniques & Technologies Award: Inferior Screw Fixation Decreases Acetabular Component Failure Following Revision Total Hip Arthroplasty. J Arthroplasty 2024; 39:S8-S12. [PMID: 38649067 DOI: 10.1016/j.arth.2024.04.049] [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] [Received: 12/05/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Adjunctive screw fixation has been shown to be reliable in achieving acetabular component stability in revision total hip arthroplasty (THA). The purpose of this study was to assess the effect of inferior screw placement on acetabular component failure following revision THA. We hypothesized that inferior screw fixation would decrease acetabular failure rates. METHODS We reviewed 250 patients who had Paprosky Type II or III defects who underwent acetabular revision between 2001 and 2021 across three institutions. Demographic factors, the number of screws, location of screw placement (superior versus inferior), use of augments and/or cup-cage constructs, Paprosky classification, and presence of discontinuity were documented. Multivariate regression was performed to identify the independent effect of inferior screw fixation on the primary outcome of aseptic rerevision of the acetabular component. RESULTS At a mean follow-up of 53.4 months (range, 12 to 261), 16 patients (6.4%) required re-revision for acetabular loosening. There were 140 patients (56.0%) who had inferior screw fixation, all of whom did not have neurovascular complications during screw placement. Patients who had inferior screws had a lower rate of acetabular rerevision than those who only had superior screw fixation (2.1 versus 11.8%, P = .0030). Multivariate regression demonstrates that inferior screw fixation decreased the likelihood of rerevision for acetabular loosening when compared to superior screw fixation alone (odds ratio: 0.1, confidence interval: 0.03 to 0.5; P = .0071). No other risk factors were identified. CONCLUSIONS Inferior screw fixation is a safe and reliable technique to reduce acetabular component failure following revision THA in cases of severe acetabular bone loss.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Ashish Mittal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Brian Velasco
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colin Baker
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Nicholas A Vandal
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Tyler J Humphrey
- Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Neil P Sheth
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Bellas NJ, Baltrusaitis D, Torre BB, Baldino JB, Sedghi TI, Marrero DE, Solovyova O. Determination of a Safe Zone for Ischial Screw Placement in Total Hip Arthroplasty. J Arthroplasty 2024; 39:157-161. [PMID: 37479194 DOI: 10.1016/j.arth.2023.07.010] [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] [Received: 03/05/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Implantation of acetabular components with supplemental screw fixation is commonly performed to improve osteointegration and long-term stability in total hip arthroplasty (THA). Placement of ischial screws improves stability in biomechanical studies, but can be technically challenging. The study aimed to provide a safe zone for ischial screw placement with reference to easily identifiable intra-operative landmarks. METHODS A retrospective review of patients was performed and 27 preoperative pelvis computed tomography scans were collected. After converting these images to 3-dimensional reconstructions of the pelvis, a safe zone for ischial screw placement was established with reference to the anterior superior iliac spine (ASIS) and the acetabular center and rim. RESULTS The safe zone of an ischial screw in the en face sagittal plane was a median of 17 degrees (interquartile range [IQR]: 11,23) anterior to 13 degrees (IQR: 10,18) posterior to the reference line from the ASIS through the center of the acetabulum. The safe zone in the coronal plane was 34 degrees (IQR: 18,68) medial to 13 degrees (IQR: 8,19) lateral from a start point 1 centimeter medial to the inferior acetabular rim with a screw length of 25 millimeters. An ischial screw optimized for length directed down the center of the ischium was qualitatively demonstrated to have a start point unobtainable intraoperatively, originating within the cotyloid fossa. CONCLUSION The ASIS, center of the acetabulum, and acetabular rim provide identifiable intraoperative landmarks for guiding ischial screw placement in hip arthroplasty.
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Affiliation(s)
- Nicholas J Bellas
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - David Baltrusaitis
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - Barrett B Torre
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - Joshua B Baldino
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - Tannaz I Sedghi
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - Daniel E Marrero
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
| | - Olga Solovyova
- Department of Orthopedics, The University of Connecticut, Farmington, Connecticut
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Nam HJ, Lim YW, Jo WL, Bahk JH, Kwon SY, Park HC, AlShammari SM. Is the construct stability of the acetabular cup affected by the acetabular screw configuration in bone defect models? J Orthop Surg Res 2023; 18:354. [PMID: 37173688 PMCID: PMC10176723 DOI: 10.1186/s13018-023-03845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND In revision surgery with significant segmental acetabular defects, adequate implant selection and fixation methods are critical in determining successful bony ingrowth. Commercially available total hip prosthesis manufacturers generally offer additional multi-hole options of acetabular shells with identical designs for use in revision THAs where screw holes configurations vary from product to product. This study aims to compare the mechanical stability of the two types of acetabular screw constructs for the fixation of acetabular components: spread-out and pelvic brim-focused configurations. METHODS We prepared 40 synthetic bone models of the male pelvis. In half of the samples with acetabular defects, identical curvilinear bone defects were manually created using an oscillating electrical saw. On the right side, multi-hole-cups in which the direction of the screw holes are centered on the pelvic brim (brim-focused) and, on the left side, multi-hole-cups with the direction of the screw hole spread throughout the acetabulum (spread-out) were implanted into the pelvic synthetic bones. Coronal lever-out and axial torsion tests were performed with a testing machine, measuring load versus displacement. RESULTS The average torsional strengths were significantly higher in the spread-out group over the brim-focused group regardless of the presence of the segmental defect of the acetabulum (p < 0.001). But for the lever-out strength, the spread-out group exhibited significantly higher average strength over the brim-focused group for the intact acetabulum (p = 0.004), whereas the results were reversed in the brim-focused group when the defects were generated (p < 0.001). The presence of acetabular defects reduced the average torsional strengths of the two groups by 68.66% versus 70.86%. In comparison, the decrease in the average lever-out strength was less significant for the brim-focused group than the spread-out group (19.87% vs. 34.25%) (p < 0.001). CONCLUSION Constructs of multi-hole acetabular cups with the spread-out screw holes configuration exhibited statistically better axial torsional strength and coronal lever-out strength. With the presence of posterior segmental bone defects, the spread-out constructs demonstrated significantly better tolerance to axial torsional strength. Still, they exhibited inverted results of higher lever-out strength in the pelvic brim-focused constructs.
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Affiliation(s)
- Ho-Jin Nam
- Asan Catholic Orthopedic Clinic, 13 Baebang-ro, Baebang-eup, Asan-si, Chungcheongnam-do, 31482, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea.
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Ji Hoon Bahk
- Department of Orthopaedic Surgery, School of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, 327, Sosa-ro, Bucheon-si, 14647, Gyeonggi-do, Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Hyung Chul Park
- Department of Orthopaedic Surgery, School of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, 06591, Seoul, Korea
| | - Saad Mohammed AlShammari
- Department of Orthopaedic Surgery, King Abdulaziz Air Base Hospital, Ministry of Defence, 75M2+R7R, King Abdel Aziz Air Base, Dhahran, 34641, Saudi Arabia
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Shaarani SR, Jaibaji M, Yaghmour KM, Vles G, Haddad FS, Konan S. Early clinical and radiological outcomes of the new porous titanium shell in combination with locking screw in revision total hip arthroplasty. ARTHROPLASTY 2023; 5:24. [PMID: 37158971 PMCID: PMC10169346 DOI: 10.1186/s42836-023-00177-4] [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: 10/03/2022] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Extensive acetabular bone loss and poor bone quality are two key challenges often encountered in revision total hip arthroplasty. A new 3D-printed porous acetabular shell has been made available with the option to insert multiple variable-angle locking screws. We sought to evaluate the early clinical and radiological outcomes of this construct. METHODS A retrospective review of patients operated by two surgeons was performed in a single institution. Fifty-nine revision hip arthroplasties were performed in 55 patients (34 female; mean age 68.8 ± 12.3 years) for Paprosky defects I (n = 21), IIA/B (n = 22), IIC (n = 9), III (n = 7) between February 2018 and January 2022 using the novel porous titanium acetabular shell and multiple variable angle locking screws. Postoperative clinical and radiographic outcomes were locally maintained. Patient-reported outcome measures collected included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score, and the 12-item Short Form Survey. RESULTS After a mean follow-up of 25.7 ± 13.9 months, two cases of shell migration were noted. One patient had a failed constrained mechanism and received revision to a cemented dual mobility liner. No other acetabular shells showed any evidence of radiographic loosening at the final follow-up. Preoperatively, 21 defects were classified as Paprosky grade I, 19 grade IIA, 3 grade IIB, 9 IIC, 4 grade IIIA, and 3 IIIB. The mean postoperative WOMAC function score was 84 (SD 17), WOMAC (stiffness) 83 (SD 15), WOMAC (pain) 85 (SD 15), and WOMAC (global) 85 (SD 17). The mean postoperative OHS was 83 (SD 15), and mean SF-12 physical score was 44 (SD 11). CONCLUSION The additional augmentation of porous metal acetabular shells with multiple variable-angle locking screws provides reliable initial fixation with good clinical and radiological outcomes in the short term. Further studies are needed to establish the medium- and long-term outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shahril R Shaarani
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK.
| | | | | | - Georges Vles
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
| | - Fares S Haddad
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
| | - Sujith Konan
- Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK
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Kaplan NB, Barra MF, Jubril A, Knapp E, Awad H, Ginnetti J. Effects of Acetabular Screws on the Initial Stability of Porous Coated Acetabular Implants in Revision Total Hip Arthroplasty. Cureus 2023; 15:e38257. [PMID: 37252568 PMCID: PMC10225166 DOI: 10.7759/cureus.38257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty in the setting of acetabular bone loss remains a challenging clinical entity. Deficiencies of the acetabular rim, walls, and/or columns may limit the bony surface area and initial acetabular construct stability necessary for osseointegration of cementless components. Press-fit acetabular components with supplemental acetabular screw fixation represent a common technique aimed to minimize implant micromotion and allow for definitive osseointegration. Although acetabular screw fixation is commonly practiced in revision hip arthroplasty, few studies to date have examined the screw properties associated with maximal acetabular construct stability. The purpose of the present report is to examine acetabular screw fixation in a pelvis model mimicking Paprosky IIB acetabular bone loss. METHODS Measuring bone-implant interface micromotion as a surrogate for initial implant stability, experimental models assessed the effect of screw number, screw length, and screw position on construct stability subject to a cyclic loading protocol designed to replicate joint reaction forces of two common daily activities. RESULTS Trends towards increasing stability were demonstrated with increasing screw number, increasing screw length, and concentrating screws in the supra-acetabular dome. All experimental constructs yielded micromotion levels sufficient for bone ingrowth, except when screws in the dome were moved to the pubis and ischium. CONCLUSIONS When using a porous coated revision acetabular implant to treat Paprosky IIB defects, screws should be used, and furthermore, increasing number, length, and position within the acetabular dome may help further stabilize the construct.
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Affiliation(s)
- Nathan B Kaplan
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Matthew F Barra
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Ayodeji Jubril
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
| | - Emma Knapp
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, USA
| | - Hani Awad
- Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research/Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, USA
| | - John Ginnetti
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA
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Hinckley NB, Beauchamp CP, Christopher ZK, Schwartz AJ, Ogunleye T, Goulding KA. What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium "monoflange". J Surg Oncol 2023; 127:480-489. [PMID: 36255157 DOI: 10.1002/jso.27124] [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: 06/01/2022] [Revised: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Innovations in machined and three-dimensionally (3D) printed implant technology have allowed for customized complex pelvic reconstructions. We sought to determine the survivorship of custom hemipelvis reconstruction using ilium-only fixation at a minimum 2-year follow-up, their modes of failure, and the postoperative complications resulting from the procedure. METHODS A retrospective review identified 12 consecutive patients treated with custom hemipelvis reconstruction. Indications for surgery were bone tumor requiring internal hemipelvectomy (four patients) or multiply revised, failed hip arthroplasty with massive bone loss (eight patients). All patients had a minimum of 2-year follow-up with a mean of 60.5 months. Kaplan-Meier survivorship analysis was determined for all patients. Postoperative complications and reoperations were categorized for all patients. RESULTS At a mean of 60.5 months, 11 of 12 patients had retained their custom implant (92% survivorship). One implant was removed as a result of an acute periprosthetic joint infection (PJI). There were no cases of aseptic loosening. Seven of 12 patients required reoperation (three PJI; two dislocations; two superficial wound complications), with five patients going on to reoperation-free survival. CONCLUSIONS Custom hemipelvis reconstruction utilizing an ilium monoflange provides durable short-term fixation at a minimum 2-year follow-up. Reoperation for infection and dislocation is common.
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Affiliation(s)
| | | | | | - Adam J Schwartz
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
| | - Temi Ogunleye
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | - Krista A Goulding
- Mayo Clinic Arizona, Department of Orthopedic Surgery, Phoenix, Arizona, USA
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Madanipour S, Lemanu D, Jayadev C, Aston W, Donaldson J, Miles J, Carrington R, McCulloch R, Skinner J. Ischial screw fixation can prevent cup migration in 3D-printed custom acetabular components for complex hip reconstruction. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:52. [PMID: 36474284 PMCID: PMC9724270 DOI: 10.1186/s42836-022-00154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Custom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration. METHODS Electronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event. RESULTS No ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X2 = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X2 = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X2 = 1.2, P = 0.26). CONCLUSION The results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.
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Affiliation(s)
- Suroosh Madanipour
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Daniel Lemanu
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Chethan Jayadev
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Will Aston
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - James Donaldson
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Jonathan Miles
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Richard Carrington
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - Robert McCulloch
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
| | - John Skinner
- grid.416177.20000 0004 0417 7890Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP UK
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Huang Y, Tang H, Zhou Y, Shao H, Yang D, Zhou B. Extended Ischiopubic Fixation Using Porous Metal Augments in Cementless Acetabular Reconstruction during Revision Total Hip Arthroplasty. Orthop Surg 2022; 14:2480-2488. [PMID: 36028942 PMCID: PMC9531101 DOI: 10.1111/os.13462] [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: 02/08/2021] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The aims of this study were to introduce the definition, indication, and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical, radiographic results and complications of hips revised with EIF. Methods Patients who underwent revision THA utilizing the technique of EIF which was defined as securing the porous metal augment >5 mm deep into the ischium and/or pubic ramus to gain adequate mechanical support and fresh host bone for bony ingrowth in a single institution from February 2015 to February 2020 were retrospectively reviewed. After applying the inclusion and exclusion criteria, a total of 30 hips (28 patients) were eligible for the study and were enrolled. Four patients were lost to follow‐up postoperatively. The data of the remaining 24 patients (26 hips) were analyzed. The patients' clinical results were assessed using of the Harris Hip Score and any complications including postoperative periprosthetic joint infection, intraoperative fracture, postoperative periprosthetic fracture, dislocation, nerve palsy, hematoma or wound complication were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation, and cup orientation. Results The median age of these 25 patients was 62.00 (interquartile: 54.25–68.25) years, with a median body mass index (BMI) of 22.60 kg/m2 (interquartile: 21.49–25.12 kg/m2). A total of 12 (48%) patients were female. At a median duration of follow‐up of 49.16 months, 20 (80%) patients rated their satisfaction level as “very satisfied,” five (20%) were “satisfied.” The median HHS improved from 36.00 (interquartile range: 31.25–49.75) preoperatively to 81.00 (interquartile range: 74.75–88.25) at the most recent follow‐up (p < 0.001). No complications such as periprosthetic joint infection, intraoperative fracture, periprosthetic fracture, dislocation, nerve palsy, hematoma, or wound complication were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative centers of rotation to the anatomic center of rotation improved from 13.62 and 8.68 mm preoperatively to 4.42 and 4.19 mm at final follow‐up (p < 0.001). Conclusions Early follow‐up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation, and restoration of the center of rotation.
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Affiliation(s)
- Yong Huang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hao Tang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Baochun Zhou
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
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10
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Brodt S, Boersch V, Strube P, Wassilew G, Matziolis G. Defining the canal for ischial and pubic screws in cup revision surgery. INTERNATIONAL ORTHOPAEDICS 2022; 46:2547-2552. [PMID: 35994066 PMCID: PMC9556370 DOI: 10.1007/s00264-022-05552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022]
Abstract
Purpose When revising acetabular cups, it is often necessary to provide additional stabilisation with screws. In extensive defect situations, the placement of screws caudally in the ischium and/or pubis is biomechanically advantageous. Especially after multiple revision operations, the surgeon is confronted with a reduced bone stock and unclear or altered anatomy. In addition, screw placement caudally is associated with greater risk. Therefore, the present study aims to identify and define safe zones for the placement of caudal acetabular screws. Methods Forty-three complete CT datasets were used for the evaluation. Sixty-three distinctive 3D points representing bone landmark of interests were defined. The coordinates of these points were then used to calculate all the parameters. For simplified visualisation and intra-operative reproducibility, an analogue clock was used, with 12 o’clock indicating cranial and 6 o’clock caudal. Results A consistent accumulation was found at around 4.5 ± 0.3 hours for the ischium and 7.9 ± 0.3 hours for the pubic bone. Conclusions The anatomy of the ischium and pubis is sufficiently constant to allow the positioning of screws in a standardised way. The interindividual variation is low — regardless of gender — so that the values determined can be used to position screws safely in the ischium and pubis. The values determined can provide the surgeon with additional orientation intra-operatively when placing caudal acetabular screws.
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Affiliation(s)
- Steffen Brodt
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Vincent Boersch
- Clinic for Traumatology and Orthopedic Surgery, Klinikum Kassel, Kassel, Germany
| | - Patrick Strube
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Georgi Wassilew
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Georg Matziolis
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
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11
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Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
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Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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12
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Goossens Q, Pastrav LC, Mulier M, Desmet W, Vander Sloten J, Denis K. Two Different Methods to Measure the Stability of Acetabular Implants: A Comparison Using Artificial Acetabular Models. SENSORS 2020; 20:s20010254. [PMID: 31906330 PMCID: PMC6983091 DOI: 10.3390/s20010254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 11/24/2022]
Abstract
The total number of total hip arthroplasties is increasing every year, and approximately 10% of these surgeries are revisions. New implant design and surgical techniques are evolving quickly and demand accurate preclinical evaluation. The initial stability of cementless implants is one of the main concerns of these preclinical evaluations. A broad range of initial stability test methods is currently used, which can be categorized into two main groups: Load-to-failure tests and relative micromotion measurements. Measuring relative micromotion between implant and bone is recognized as the golden standard for implant stability testing as this micromotion is directly linked to the long-term fixation of cementless implants. However, specific custom-made set-ups are required to measure this micromotion, with the result that numerous studies opt to perform more straightforward load-to-failure tests. A custom-made micromotion test set-up for artificial acetabular bone models was developed and used to compare load-to-failure (implant push-out test) with micromotion and to assess the influence of bone material properties and press-fit on the implant stability. The results showed a high degree of correlation between micromotion and load-to-failure stability metrics, which indicates that load-to-failure stability tests can be an appropriate estimator of the primary stability of acetabular implants. Nevertheless, micromotions still apply as the golden standard and are preferred when high accuracy is necessary. Higher bone density resulted in an increase in implant stability. An increase of press-fit from 0.7 mm to 1.2 mm did not significantly increase implant stability.
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Affiliation(s)
- Quentin Goossens
- Department of Mechanical Engineering, Campus Group T, KU Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Leonard Cezar Pastrav
- Department of Mechanical Engineering, Campus Group T, KU Leuven, 3000 Leuven, Belgium
| | - Michiel Mulier
- Department of Orthopedics, University Hospital Leuven, 3000 Leuven, Belgium
| | - Wim Desmet
- Department of Mechanical Engineering, PMA Division, KU Leuven, 3000 Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, 3000 Leuven, Belgium
| | - Kathleen Denis
- Department of Mechanical Engineering, Campus Group T, KU Leuven, 3000 Leuven, Belgium
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, 3000 Leuven, Belgium
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13
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Tang H, Zhou B, Huang Y, Zhou Y, Chen B, Li X. Inferior extended fixation utilizing porous titanium augments improves primary anti-rotational stability of the acetabular component. Clin Biomech (Bristol, Avon) 2019; 70:158-163. [PMID: 31525656 DOI: 10.1016/j.clinbiomech.2019.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The primary anti-rotational stability is critical to preventing cup tilting failure following revision total hip arthroplasty, but is frequently compromised by severe ischial bone loss. A novel technique of "inferior extended fixation" was introduced by securing a porous metal augment into the deficient ischium. This study evaluated the effect of this technique on primary anti-rotational stability in revision total hip arthroplasty. METHODS Composite hemipelvis specimens, acetabular components and "lotus" augments were used to simulate total hip arthroplasty surgeries. Three different cementless operative settings of cup implantation were simulated: (1) native ischium without defects; (2) ischium with a defect not reconstructed; (3) ischial defect reconstructed with inferior extended fixation using a lotus augment. Lever-out testing was used to examine primary anti-rotational stability, which was measured as interface stiffness and yield moment. FINDINGS Compared with the native ischium setting, the mean interface stiffness decreased by 53.1% in the ischial defect setting (p < 0.001). In the inferior extended fixation setting, the mean value was 110% greater than that in the ischial defect setting (p = 0.014), and comparable to that in the native ischium setting (p = 1). Similar results were observed for the yield moment (declined by 63.1%, p < 0.001; 200% higher, p < 0.001; and p = 0.395; respectively). INTERPRETATION In revision total hip arthroplasty with severe ischial defects, inferior extended fixation with a lotus porous titanium augment restores anti-rotational stability of the acetabular component to the level of that with a native ischium, which provides the mechanical environment for bone ingrowth and prevents cup tilting failure.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Baochun Zhou
- Department of Orthopaedics, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China.
| | - Bo Chen
- R&D Center, AK Medical Co., Ltd, Beijing, China
| | - Xinyu Li
- R&D Center, AK Medical Co., Ltd, Beijing, China
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14
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Burkhart TA, Khadem M, Wood TJ, Dunning CE, Degen R, Lanting BA. Comparison of trans-cortical and cancellous screws to press fit for acetabular shell fixation in total hip arthroplasty: A cadaveric study. Clin Biomech (Bristol, Avon) 2019; 69:34-38. [PMID: 31295668 DOI: 10.1016/j.clinbiomech.2019.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total hip arthroplasty complications are associated with mechanical loosening of the acetabular component, which may be attributed to the type of fixation used (press fit, trans-cortical screws, cancellous screws). Therefore, the purpose of this study was to compare trans-cortical and cancellous screws to press fit for fixation of the acetabular shell. METHODS Five cadaveric pelvis specimens were hemisected (N = 10) at the sacroiliac joint. Each hemi-pelvis was initially tested with a press fit cup followed by the left and right pairs being randomized to either a cancellous or trans-cortical screw condition. Each fixation was tested by applying a load to a rod inserted into the centre of the acetabular cup at 0.5 mm/s, until failure occurred. The failure force, failure moment, and the rotation angle of the cup at failure were calculated. FINDINGS The cups fixated with a trans-cortical screw failed at a significantly greater mean [SD] force (1046.20 [386.52] N). The trans-cortical screws also significantly increased the angle of failure 46.29 (16.90) ° compared to the press-fit cups (6.73 [4.59] °). Finally, there was a significant increase in the failure moment, such that, the trans-cortical condition failed at a mean (SD) moment of 53.75 (16.24) Nm compared to 9.59 (1.85) Nm and 32.15 (18.16) Nm for the press fit and cancellous (p = 0.044) conditions, respectively. INTERPRETATION The acetabular shells that were fixated with trans-cortical screws provide greater stability compared to the press-fit cups or cancellous screws.
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Affiliation(s)
- Timothy A Burkhart
- Lawson Health Science Institute, Canada; Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada.
| | - Mehrdad Khadem
- Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Thomas J Wood
- Department of Surgery, London Health Sciences Centre, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Cynthia E Dunning
- Department of Mechanical and Materials Engineering, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Ryan Degen
- Fowler Kennedy Sports Medicine Clinic, Canada; Department of Surgery, Western University, 1151 Richmond Rd, London, ON N6A 3K7, Canada
| | - Brent A Lanting
- London Health Sciences Centre, Canada; Department of Surgery, 1151 Richmond Rd, London, ON N6A 3K7, Canada
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15
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Tetsunaga T, Fujiwara K, Endo H, Tetsunaga T, Miyake T, Yamada K, Sanki T, Ozaki T. Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia. Hip Int 2019; 29:535-542. [PMID: 30724114 DOI: 10.1177/1120700019828708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adequate initial stability of the acetabular cup is essential for total hip arthroplasty (THA). However, changes in the alignment of the acetabular component caused by screw fixation are concerning in patients with inadequate bone stock. This study aimed to investigate the effects of screw fixation on the alignment of the acetabular component in THA patients with hip dysplasia. METHODS We retrospectively examined 256 hips (range 28-87 years) that underwent THA using a navigation system. Patients were divided into 2 groups based on the presence or absence of changes in the alignment of the intraoperative acetabular cup, and univariate and multivariate analyses were performed to identify factors that were predictive of changes in acetabular component alignment after screw fixation in 2 dimensions: inclination and anteversion. RESULTS Screw fixation led to a mean change in inclination of 1.6° (range 0-10°) and a mean change in anteversion of 1.4° (range 0-14°). The Crowe classification, the presence of bone cysts, and the use of an inferior quadrant screw were identified as factors that correlated with acetabular cup alignment changes in inclination (odds ratios, 6.01, 5.94 and 0.03, respectively). Only the Crowe classification was identified as a factor that correlated with intraoperative alignment changes in anteversion (odds ratio, 2.08). CONCLUSIONS Screw fixation altered the acetabular cup alignment. The inclination changes were related to the extent of the dysplasia, and the risk was reduced when the inferior quadrant screw was used. Surgeons should use caution during screw fixation in THAs performed on severely dysplastic hips.
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Affiliation(s)
| | - Kazuo Fujiwara
- 2 Department of Intelligent Orthopaedic System Development, Okayama University, Japan
| | - Hirosuke Endo
- 1 Department of Orthopaedics, Okayama University, Japan
| | | | | | - Kazuki Yamada
- 1 Department of Orthopaedics, Okayama University, Japan
| | - Tomoaki Sanki
- 1 Department of Orthopaedics, Okayama University, Japan
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16
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Long WJ, Nayyar S, Chen KK, Novikov D, Davidovitch RI, Vigdorchik JM. Early aseptic loosening of the Tritanium primary acetabular component with screw fixation. Arthroplast Today 2018; 4:169-174. [PMID: 29896547 PMCID: PMC5994600 DOI: 10.1016/j.artd.2017.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 10/31/2022] Open
Abstract
Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component's clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation. They all presented with groin and hip pain after index surgery and underwent follow-up radiographic examination consistent with component loosening requiring revision surgery. This case series reports on the risk of early acetabular cup loosening and its associated clinical presentation, workup, and surgical management in patients with the Tritanium primary cup augmented with screws.
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Affiliation(s)
- William J. Long
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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17
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Wu H, Ma C, Ran J, Xu D, Liu A, Sun M, Wu L, Yan S. Biomechanical research on contour cage with transacetabular screws fixation in revision total hip arthroplasty. Clin Biomech (Bristol, Avon) 2017; 47:117-122. [PMID: 28662423 DOI: 10.1016/j.clinbiomech.2017.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 06/12/2017] [Accepted: 06/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use biomechanical technique to access the strain distribution and stability of Contour anti-protrusion cage with or without the whole circumference acetabular cup fixation by the transacetabular screws. METHODS Pelvic specimens from 10 male cadavers were used for the biomechanical test. The models of type C bone defect were copied according to the AAOS classification. Group 1: the contour reconstruction ring was fixed only by flange screws; Group 2: the contour reconstruction ring was fixed both by flange screws and transacetabular screws in dome. Under load in Heel Strike, Midstance, and Toe off phase, the transverse and longitudinal strains were measured in both the superior measure site near the root of the iliac wing and the inferior measure site near the root of the ischium. The relative displacement between the anterior inferior spine and the root of ischium below acetabular component was also measured. FINDINGS Compared with Group 1, the transverse and longitudinal pressure strain of Group 2 on the superior measure site decreased, and measure sites also showed reductions on the inferior under load under three different gait phases. The result of mean relative displacement showed transacetabular screws fixation couldn't provide significant improvement of displacement prevention. INTERPRETATION Biomechanical test showed that under the premise of a satisfied bone allograft and well-fixed flange screws in iliac and ischium, the satisfactory initial stability of the reconstruction cup can be achieved, but could not be improved by transacetabular screw technique. However, the max strain in root part of the flange will be reduced using transacetabular screws in ilium, pubis and ischium together, and the strain distribution will also be improved.
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Affiliation(s)
- Haobo Wu
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chiyuan Ma
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jisheng Ran
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Danfeng Xu
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - An Liu
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Miao Sun
- Affiliated Hospital of Stomatology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lidong Wu
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopaedic Surgery, The 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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18
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Effect of screw fixation on acetabular component alignment change in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2014; 38:1155-8. [PMID: 24414077 DOI: 10.1007/s00264-013-2271-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The use of screws can enhance immediate cup fixation, but the influence of screw insertion on cup position has not previously been measured. The purpose of this study was to quantitatively evaluate the effect of intra-operative screw fixation on acetabular component alignment that has been inserted with the use of a navigation system. METHODS We used a navigation system to measure cup alignment at the time of press-fit and after screw fixation in 144 hips undergoing total hip arthroplasty. We also compared those findings with factors measured from postoperative radiographs. RESULTS The mean intra-operative change of cup position was 1.78° for inclination and 1.81° for anteversion. The intra-operative change of anteversion correlated with the number of screws. The intra-operative change of inclination also correlated with medial hip centre. CONCLUSION The insertion of screws can induce changes in cup alignment, especially when multiple screws are used or if a more medial hip centre is required for rigid acetabular fixation.
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19
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Small SR, Berend ME, Howard LA, Rogge RD, Buckley CA, Ritter MA. High initial stability in porous titanium acetabular cups: a biomechanical study. J Arthroplasty 2013; 28:510-6. [PMID: 23142455 DOI: 10.1016/j.arth.2012.07.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/08/2012] [Accepted: 07/27/2012] [Indexed: 02/06/2023] Open
Abstract
Initial stability with limited micromotion in uncemented total hip arthroplasty acetabular components is essential for bony attachment and long-term biomechanical fixation. This study compared porous titanium fixation surfaces to clinically established, plasma-sprayed designs in terms of interface stability and required seating force. Porous plasma-sprayed modular and metal-on-metal (MOM) cups were compared to a modular, porous titanium designs. Cups were implanted into polyurethane blocks with1-mm interference fit and subsequently edge loaded to failure. Porous titanium cups exhibited 23% to 65% improvement in initial stability when compared to plasma-sprayed cup designs (P=.01): a clinically significant increase, based on experience and prior literature. The results of this study indicate increased interface stability in porous titanium-coated cups without significantly increasing the necessary force and energy required for full seating.
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Affiliation(s)
- Scott R Small
- Joint Replacement Surgeons of Indiana Foundation, Inc., Mooresville, Indiana, USA
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