1
|
Curtin M, Russell SP, Mirdad RS, Irwin SC, Rowan FE, Masterson EL, Condon F. Long-term outcomes of acetabular impaction grafting with cemented cups and trabecular metal for revision hip arthroplasty: a follow-up study. Hip Int 2024:11207000241266939. [PMID: 39252465 DOI: 10.1177/11207000241266939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Revision hip arthroplasty in the presence of complex acetabular deficiencies is challenging. Cement, allograft, reconstruction rings and porous trabecular metal now provide versatile options for acetabular fixation and restoration of acetabular offset. We compare acetabular impaction bone grafting (AIBG) and trabecular metal (TM) cups at long-term follow-up. METHODS 53 patients who underwent revision hip arthroplasty were retrospectively reviewed from local joint registry data. 36 patients were revised using AIBG and 17 with TM. Median clinical follow-up was 9.57 (2.46-18.72) years and 9.65 (7.22-12.46) years, respectively. 82% of the TM group and 63% of the AIBG group were ⩾ Paprosky 2C. Re-revision was considered failure. Radiographs demonstrating 5 mm of femoral head migration and 5° of acetabular component inclination change were considered loose. RESULTS Patients receiving AIBG were younger (68 vs. 74 years) with a longer interval from initial arthroplasty to revision (17 vs. 13 years). Revisions in both groups were indicated most commonly for failed cementing (AIBG 88.9% vs. TM 70.5%). No TM reconstructions underwent re-revision, with only 1 failing at 6.3 years, compared with 9 AIBG re-revisions. When revising for sepsis, 33% of AIBG revisions failed. CONCLUSIONS AIBG demonstrated high failure rates at long-term follow-up when compared to TM constructs. We recommend the use of AIBG in small cavitary defects only. We strongly advise against its use in the setting of significant bony defects and for prosthetic joint infection.
Collapse
Affiliation(s)
- Mark Curtin
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - Shane P Russell
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | | | - Shane C Irwin
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - Fiachra E Rowan
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - Eric L Masterson
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - Finbarr Condon
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
2
|
D'Agostino C, Di Martino A, Cataldi P, Schilardi F, Brunello M, Geraci G, Bordini B, Traina F, Faldini C. A Registry Study on Acetabular Revisions Using Jumbo Cups: Do We Really Need a More Complex Revision Strategy? J Arthroplasty 2024:S0883-5403(24)00885-4. [PMID: 39233106 DOI: 10.1016/j.arth.2024.08.041] [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: 04/22/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND The increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision. METHODS A cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were "cup aseptic loosening" (54.5%) and "total aseptic loosening," which included both the cup and stem (32%). RESULTS The JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were "cup aseptic loosening" (40%), "total aseptic loosening" (17.1%), and "septic loosening" (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases). CONCLUSIONS This registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.
Collapse
Affiliation(s)
- Claudio D'Agostino
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Alberto Di Martino
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Piergiorgio Cataldi
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesco Schilardi
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giuseppe Geraci
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; Department of Orthopaedics and Traumatology and Hip and Knee Arthroplasty and Revisions, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Garner E, Meynen A, Schey L, Wu J, Zadpoor AA. Automated design of bone-preserving, insertable, and shape-matching patient-specific acetabular components. J Orthop Res 2024. [PMID: 39004739 DOI: 10.1002/jor.25927] [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: 01/31/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024]
Abstract
Effective treatment of large acetabular defects remains among the most challenging aspects of revision total hip arthroplasty (THA), due to the deficiency of healthy bone stock and degradation of the support columns. Generic uncemented components, which are favored in primary THA, are often unsuitable in revision cases, where the bone-implant contact may be insufficient for fixation, without significant reaming of the limited residual bone. This study presents a computational design strategy for automatically generating patient-specific implants that simultaneously maximize the bone-implant contact area, and minimize bone reaming while ensuring insertability. These components can be manufactured using the same additive manufacturing methods as porous components and may reduce cost and operating-time, compared to existing patient-specific systems. This study compares the performance of implants generated via the proposed method to optimally fitted hemispherical implants, in terms of the achievable bone-implant contact surface, and the volume of reamed bone. Computer-simulated results based on the reconstruction of a set of 15 severe pelvic defects (Paprosky 2A-3B) suggest that the patient-specific components increase bone-implant contact by 63% (median: 63%; SD: 44%; 95% CI: 52.3%-74.0%; RMSD: 42%), and reduce the volume of reamed bone stock by 97% (median: 98%; SD: 4%; 95% CI: 95.9%-97.4%; RMSD: 3.7%).
Collapse
Affiliation(s)
- Eric Garner
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alexander Meynen
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Lennart Schey
- Department of Development and Regeneration, Faculty of Medicine, Institute for Orthopedic Research and Training (IORT), KU Leuven, Leuven, Belgium
| | - Jun Wu
- Department of Sustainable Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Amir A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| |
Collapse
|
5
|
Loppini M, Guazzoni E, Gambaro FM, La Camera F, Morenghi E, Grappiolo G. A new classification to characterize and predict treatment of acetabular bone defects. Arch Orthop Trauma Surg 2024; 144:2975-2981. [PMID: 38864926 DOI: 10.1007/s00402-024-05327-0] [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: 02/12/2024] [Accepted: 04/14/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The increasing amount of revision surgeries in total hip arthroplasty (THA) represents a burden for orthopedic surgeons given the complexity and unpredictability of this kind of surgery. The aim of the current study was to develop a new radiographic classification of acetabular bone defects stratify the severity of the lesion and to suggest the surgical strategy to address it. METHODS Radiographs of 151 consecutive patients who underwent acetabular revision surgery in our institution were collected to develop a new classification that groups the acetabular bone defects in three zones (A, B and C). The performance to predict treatment and inter- and intra-rater agreement were evaluated. RESULTS The ability of the newly proposed classification to predict treatment was 87.3% (k weighted: 0.65). The inter-rater reliability was 90.1% (k: 0.81), and the intra-rater reliability between the two sets of evaluations performed by the observer at 1-month distance was 97.5% (k: 0.94). CONCLUSIONS The newly proposed classification was able to characterize the extent of acetabular bone defects and predict pre-operatively the appropriate surgical treatment strategy in 87.3% of cases. It showed a strong agreement among raters and an almost perfect agreement among different measurements at 1 month distance. This new tool could be used in the preoperative assessment to drive the use of secondary level image examinations and the type of surgical management.
Collapse
Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy.
- IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy.
| | - Edoardo Guazzoni
- IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy
| | - Francesco Manlio Gambaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Francesco La Camera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, Milan, 20089, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy
| |
Collapse
|
6
|
朱 家, 孙 家, 刘 金, 马 博, 张 驰, 张 超, 夏 天, 沈 计. [Effectiveness analysis of revision surgery after total hip arthroplasty assisted by artificial intelligence preoperative planning system]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:455-460. [PMID: 38632066 PMCID: PMC11024537 DOI: 10.7507/1002-1892.202312099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Objective To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning (AIHIP) system. Methods The clinical data of 22 patients (23 hips) who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed. There were 12 males and 10 females with an average age of 69.7 years (range, 44-90 years). There were 19 hips in the first revision, 3 hips in the second revision, and 1 hip in the third revision. The causes of revision included 12 hips with prosthesis loosening, 4 hips with acetabular cup loosening, 3 hips with osteolysis, 2 hips with acetabular dislocation, 1 hip with postoperative infection, and 1 hip with prosthesis wear. There were 6 hips in stage ⅡA, 9 hips in stage ⅡB, 4 hips in stage ⅡC, 3 hips in stage ⅢA, and 1 hip in stage ⅢB according to Paprosky staging of acetabular bone defect. The replacement of prosthesis type, operation time, hospitalization stay, ground active condition, and postoperative infection, fracture, prosthesis loosening, and other adverse events were recorded. The function of the affected limb was evaluated by Harris score before operation, at 1 week and 6 months after operation, and the range of motion of the hip joint was compared before operation and at 6 months after operation. Results The operation time was 85-510 minutes, with an average of 241.8 minutes; the hospitalization stay was 7-35 days, with an average of 15.2 days; the time of disassociation from the walker was 2-108 days, with an average of 42.2 days. All the 22 patients were followed up 8-53 months (mean, 21.7 months). No adverse events such as prosthesis loosening or infection occurred in the rest of the patients, except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip. The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip (+2), the matching rate was 95.65%. The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip (-1), and the matching rate was 100%. The Harris scores were 55.3±9.8 and 89.6±7.2 at 1 week and 6 months after operation, respectively, which significantly improved when compared with before operation (33.0±8.6, P<0.05), and further improved at 6 months after operation than at 1 week after operation ( P<0.05). The function of hip joint was evaluated by Harris score at 6 months after operation, and 21 hips were good and 2 hips were moderate, which could meet the needs of daily life. The range of motion of hip joint was (111.09±10.11)° at 6 months after operation, which was significantly different from (79.13±18.50)° before operation ( t=-7.269, P<0.001). Conclusion AIHIP system can improve the accuracy of revision surgery, reduce the difficulty of surgery, and achieve good postoperative recovery and satisfactory short-term effectiveness.
Collapse
Affiliation(s)
- 家庆 朱
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 家豪 孙
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 金柱 刘
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 博闻 马
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 驰宇 张
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 超 张
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 天卫 夏
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 计荣 沈
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| |
Collapse
|
7
|
Özdemir E, de Lange B, Buckens CFM, Rijnen WHC, Visser J. Bone support of a custom triflange acetabular component over time. Bone Joint J 2024; 106-B:359-364. [PMID: 38555950 DOI: 10.1302/0301-620x.106b4.bjj-2023-0668.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims To investigate the extent of bone development around the scaffold of custom triflange acetabular components (CTACs) over time. Methods We performed a single-centre historical prospective cohort study, including all patients with revision THA using the aMace CTAC between January 2017 and March 2021. A total of 18 patients (18 CTACs) were included. Models of the hemipelvis and the scaffold component of the CTACs were created by segmentation of CT scans. The CT scans were performed immediately postoperatively and at least one year after surgery. The amount of bone in contact with the scaffold was analyzed at both times, and the difference was calculated. Results The mean time between the implantation and the second CT scan was two years (1 to 5). The mean age of the patients during CTAC implantation was 75 years (60 to 92). The mean scaffold-bone contact area increased from 16% (SD 12.6) to 28% (SD 11.9). The mean scaffold-bone distance decreased from a mean of 6.5 mm (SD 2.0) to 5.5 mm (SD 1.6). None of the CTACs were revised or radiologically loose. Conclusion There was a statistically significant increase of scaffold-bone contact area over time, but the total contact area of the scaffold in relation to the acetabular bone remained relatively low. As all implants remained well fixed, the question remains to what extend the scaffold contributes to the observed stability, in relation to the screws. A future design implication might be an elimination of the bulky scaffold component. This design modification would reduce production costs and may optimize the primary fit of the implant.
Collapse
Affiliation(s)
- Erim Özdemir
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bram de Lange
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Wim H C Rijnen
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jetze Visser
- Department of Orthopedics, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
8
|
Kaszuba SV, Hurley M, Beitler BG, Abraham PF, Tommasini S, Schwarzkopf R, Wiznia DH. A review of the design, manufacture, and outcomes of custom total joint replacement implants available in the United States. J Clin Orthop Trauma 2024; 49:102354. [PMID: 38361508 PMCID: PMC10865390 DOI: 10.1016/j.jcot.2024.102354] [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: 07/02/2023] [Accepted: 01/31/2024] [Indexed: 02/17/2024] Open
Abstract
Custom total joint replacement (TJA) implants, specifically designed and manufactured for each patient, have emerged as surgeons seek to improve functional outcomes of primary total joint replacement, as well as treat patients with complex primary deformities, bone defects, and revision surgeries. The purpose of this review is to present the various custom total hip and knee arthroplasty implants available in the United States for primary and revision cases, so that surgeons can understand the design considerations and manufacturing processes of custom implants, as well as their performance compared to standard implants.
Collapse
Affiliation(s)
- Stephanie V. Kaszuba
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Margaret Hurley
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Brian G. Beitler
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Steven Tommasini
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
9
|
Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, De Martino I, Risitano S, Sabatini L, Massè A, Cavaliere P. Trabecular titanium cups in hip revision surgery: a systematic review of the literature. ANNALS OF JOINT 2023; 8:36. [PMID: 38529221 PMCID: PMC10929389 DOI: 10.21037/aoj-23-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/24/2023] [Indexed: 03/27/2024]
Abstract
Background Hip revision surgery in extensive acetabular bone defects represents a complex challenge for hip surgeons. The primary goal is to obtain a stable acetabular component and restore the hip biomechanics. Through the years, different prosthetic implants have been developed to perform acetabular revision depending on bone loss location and extension. This systematic review aims to summarize the clinical outcomes and complications reported with trabecular titanium (TT) cups in hip revision surgery. Methods A literature search of four databases (PubMed, Embase, Scopus and the Cochrane Database of systematic reviews) was performed according to the PRISMA guideline from January 2008 to December 2022. All studies written in English and reporting the clinical outcome of patients undergoing revision total hip arthroplasty using Delta TT cups were included. The initial screening identified 378 studies. Each eligible clinical article was analyzed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE), and the papers' methodological quality was evaluated using The Methodological Index for Non-Randomized Studies Criteria (MINORS) score. Results Eight clinical studies were included in the analysis. A total of 523 hip revisions were analyzed. Delta TT cups were used in 3.9%, Delta TT one cups in 46.8%, and Delta TT revisions in 49.3%. Paprosky IIIa was the most frequent acetabular bone defect reported in 26.4% of cases. The overall survival rate of TT cups was 93.4%. The dislocation was the most frequent complication in 4.1% of patients, while the prevalence of aseptic loosening was 1.5. Conclusions Managing severe acetabular bone defects remains a complex challenge for hip surgeons. Since their introduction, TT cups have exhibited good clinical results, with complication rates in line with or lower than those reported by similar implants.
Collapse
Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
| | | | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
| |
Collapse
|
10
|
Abu-Zeid MY, Habib MES, Marei SM, Elbarbary ANE, Ebied AA, Mesregah MK. Impaction bone grafting for contained acetabular defects in total hip arthroplasty. J Orthop Surg Res 2023; 18:671. [PMID: 37697375 PMCID: PMC10494409 DOI: 10.1186/s13018-023-04154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. METHODS In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. RESULTS This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. CONCLUSIONS IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Mohamed Yousry Abu-Zeid
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed El-Sawy Habib
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Sameh Mohamed Marei
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Nasr-Eldin Elbarbary
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Ahmed Ali Ebied
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin-El-Kom, Menoufia, Egypt.
| |
Collapse
|
11
|
Kim HS, Kim JW, Chang JS, Kim CH. Revision Total Hip Arthroplasty Utilizing an Acetabular Reinforcement Ring with a Metal Augment: A Minimum Eight-Year Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1036. [PMID: 37374240 DOI: 10.3390/medicina59061036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An acetabular reinforcement ring (ARR) with a structural allograft is conventionally used to treat large acetabular bone defects or discontinuity during revision hip arthroplasty. However, ARR is prone to failure due to bone resorption and lack of incorporation. Here, we investigated the surgical outcomes of the patients who underwent revision total hip arthroplasty (THA) using ARR combined with a metal augment (MA). Materials and Methods: We retrospectively reviewed data from 10 consecutive patients who had a minimum 8-year follow-up after revision hip arthroplasty using ARR with MA in Paprosky type III acetabular defect. We collected patient demographics, surgical details, clinical scores (including Harris Hip Score (HHS)), postoperative complications, and 8-year survival rates. Results: Six male and four female patients were included. The mean age was 64.3 years, and the mean follow-up duration was 104.3 months (96.0-112.0 months). Trauma-related diagnosis was the most common reason for index surgery. Three patients underwent all component revision, and seven underwent cup revision. Six were confirmed as Paprosky type IIIA and four as type IIIB. The mean HHS at the final follow-up was 81.5 (72-91). One patient was diagnosed with prosthetic joint infection at the 3-month follow-up; therefore, the minimum 8-year survival rate with our technique was 90.0% (95% confidence interval, 90.3-118.5%). Conclusions: The satisfactory mid- to long-term results of revision THA suggest that ARR combined with tantalum MA is a viable revision option for treating severe acetabular defects with pelvic discontinuity.
Collapse
Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Giachino M, Aprato A, Limone B, Ciccone G, Rosso T, Massè A. Impact of three-dimensional printed planning in Paprosky III acetabular defects: a case-control and cost-comparison analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:1465-1472. [PMID: 36930258 DOI: 10.1007/s00264-023-05763-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE The main challenges in revision total hip arthroplasty (rTHA) are the treatment of the bone loss and the pre-operative planning. 3D-printed models may enhance pre-operative planning. The aim of the study is to compare the intra- and peri-operative results and costs for Paprosky type 3 rTHAs planned with 3D-printed models to ones accomplished with the conventional imaging techniques (X-rays and CT scan). METHODS Seventy-two patients with Paprosky type 3 defect underwent rTHA between 2014 and 2021. Fifty-two patients were treated with standard planning and 20 were planned on 3D-printed models. Surgical time, intra-operative blood loss, number of transfused blood units, number of post-operative days of hospitalization, and use of acetabular rings were compared between the two groups. A costs comparison was also performed. RESULTS The 3D-printed group showed reduced operative time (101.8 min (SD 27.7) vs. 146.1 min (SD 49.5), p < 0.001) and total days of hospitalization (9.3 days (SD 3.01) vs. 12.3 days (SD 6.01), p = 0.009). The cost of the procedures was significantly lower than the control group, with an adjusted difference of 4183 euros (p = 0.004). No significant differences were found for the number of total transfused blood units and blood loss and the number of acetabular rings. CONCLUSION The use of 3D-printed models led to a meaningful cost saving. The 3D-printed pre-operative planning for complex rTHAs seems to be effective in reducing operating time, hospital stay and overall costs.
Collapse
Affiliation(s)
- M Giachino
- Department of Traumatology Orthopaedic and Occupational Medicine, University of Study of Turin, Medicine School (CTO Hospital), Turin, Italy.
| | - A Aprato
- Department of Traumatology Orthopaedic and Occupational Medicine, University of Study of Turin, Medicine School (CTO Hospital), Turin, Italy
| | - B Limone
- Department of Traumatology Orthopaedic and Occupational Medicine, University of Study of Turin, Medicine School (CTO Hospital), Turin, Italy
| | - G Ciccone
- Clinical Epidemiology Unit, University of Study of Turin, Turin, Italy
| | - T Rosso
- Clinical Epidemiology Unit, University of Study of Turin, Turin, Italy
| | - A Massè
- Department of Traumatology Orthopaedic and Occupational Medicine, University of Study of Turin, Medicine School (CTO Hospital), Turin, Italy
| |
Collapse
|
14
|
Custom Triflange Acetabular Components For Catastrophic Bone Loss: Minimum 5-Year Results. J Arthroplasty 2023:S0883-5403(23)00044-X. [PMID: 36708935 DOI: 10.1016/j.arth.2023.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Custom acetabular components are an increasingly utilized reconstructive option in total hip arthroplasty for catastrophic bone loss and acetabular failure. The purpose of this study was to determine the survivorship of such components for reconstruction due to catastrophic bone loss at a minimum 5-year follow-up. METHODS From August 2003 to July 2016, 64 patients (66 hips) underwent acetabular reconstruction with custom triflange components. All hips were classified as Paprosky 3B or 3C. Harris hip scores were analyzed. Overall survivorship was determined by survival analysis. RESULTS Seventeen patients (18 hips) died prior to returning for 5-year follow-up. One presumed living patient was lost to contact, yielding a cohort of 46 patients (47 hips) who had minimum 5-year follow-up. The mean age was 65 years (range, 46 to 85), mean body mass index was 29.4 (range, 18 to 45), and 72% were women. Mean follow-up was 8 years (range, 5 to 16). There were 3 revisions of the triflange device (6.4%) due to infection. Survivorship to end point of triflange removal for any reason was 94.1% (95% confidence interval: ±3.4%) at a mean of 16 years. In the overall series (n = 66), there were 9 (13.6%) additional reoperations as follows: 5 incision and debridements, one open reduction internal fixation, two stem revisions for periprosthetic femoral fracture, and one head revision. Harris hip scores improved significantly from a mean of 41 points preoperatively to 64 points postoperatively. CONCLUSIONS Custom acetabular triflange components represent a highly effective tool in a surgeon's armamentarium. These devices are extremely helpful in managing catastrophic bone loss and have a good mean 16-year survival.
Collapse
|
15
|
Conversion total hip arthroplasty for early failure following unstable intertrochanteric hip fracture: what can patients expect? Arch Orthop Trauma Surg 2022; 142:3737-3745. [PMID: 34657163 DOI: 10.1007/s00402-021-04215-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To report surgical outcomes in patients treated with conversion total hip arthroplasty (CTHA) for early failure of cephalomedullary nails (CMNs). METHODS A retrospective review was conducted of CTHA for treatment of failed CMN within 1 year of initial surgery for intertrochanteric (IT) hip fractures. The cohort was matched 1:5 to patients who underwent elective primary THA (PTHA). Patient demographics, mechanism of CMN failure, surgical outcomes, and complication rates were assessed. RESULTS 22 patients met criteria with a mean time to failure of 145 days. Modes of failure included: lag screw cut-out with superior migration (9, 40.9%), or medialization (8, 36.4%), and aseptic nonunion with implant failure (2, 9.0%) and without implant failure (3, 13.6%). Fourteen of the patients (63.6%) had acetabular-sided damage secondary to lag screw penetration, all in the screw cut-out groups. Patient demographics were similar between cohorts. Compared to PTHA, CTHA patients had increased operative time, blood loss, LOS, and readmission rates. After IMN failure, the operative leg was shorter than the contralateral leg in all cases. CTHA restored leg lengths to < = 10 mm in 15 (68.1%) of patients, with an average leg length discrepancy after CTHA of 6.7 mm. CTHA patients had increased rates of overall surgical complications and medical complications, specifically anemia (all p < 0.01). Tranexamic acid was used less often in the CTHA group (p < 0.01). Rate of periprosthetic joint infection (PJI), dislocation, and revision were all higher in the CTHA, though did not reach statistical significance. CONCLUSION The majority (77.3%) of CMN implant failure for nonunion within 1 year was due to screw cut-out. CTHA is a salvage option for early failed IT hip fracture repair, but expected surgical outcomes are more similar to revision THA than primary THA, with increased risk of readmission, longer surgery and LOS, increased blood loss, and higher complication rates. LEVEL OF EVIDENCE III, Retrospective comparative study.
Collapse
|
16
|
Fujimoto Y, Nakamura S, Ijuin T, Iuchi T, Nakajo M, Taniguchi N. Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device and allogeneic structural bone graft. J Orthop Surg (Hong Kong) 2022; 30:10225536221119719. [PMID: 35976732 DOI: 10.1177/10225536221119719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE One of the major problems in revision total hip arthroplasty (THA) is severe acetabular bone loss. The aim of our study was to evaluate the clinical outcomes of revision THA using a Kerboull-type reinforcement device (KT plate) and allogeneic structural bone graft. METHODS This retrospective study evaluated 48 hips that underwent revision THA using a KT plate and allogeneic structural bone graft between 2008 and 2016, with a median follow-up of 6.2 years (range 3-12.6 years). Functional outcome was assessed using the Japanese Orthopaedic Association (JOA) hip score. Postoperative and follow-up radiographs were compared to assess migration and breakage of the implant. RESULTS The mean JOA hip score improved from 45.6 (±16.3) points before surgery to 72.1 (±11.9) points at the most recent follow-up examination (p < 0.001). Two hips (4.2%) underwent re-revision THA because of cup loosening due to breakage of the KT plate. A total of 13 hips (27.1%) were classified as radiological failures. Binomial logistic regression analysis showed that a Kawanabe classification of stage 4, which indicates massive bone defects in the weight-bearing area, was a risk factor for radiological failure (odds ratio: 4.57; 95% confidence interval: 1.01-26.35). CONCLUSIONS A KT plate with an allogeneic structural bone graft is a useful method of acetabular reconstruction in revision THA that restores bone stock and improves hip function. Our findings indicated that a Kawanabe classification of stage 4 was a risk factor for radiological failure of the implant.
Collapse
Affiliation(s)
- Yusuke Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan.,Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Shunsuke Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Toshiro Ijuin
- Department of Medical Joint Materials, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Tomohiro Iuchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Masahide Nakajo
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| | - Noboru Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, 208512Kagoshima University, Kagoshima, Japan
| |
Collapse
|
17
|
A Change in the Classical Order of Setting of Porous Metal Augments with Locked Cups in Hip Revision Surgery: Technical Note and Case Report. Case Rep Orthop 2022; 2022:4062172. [PMID: 35707266 PMCID: PMC9192304 DOI: 10.1155/2022/4062172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup. Methods We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion. Results The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation in the midterm follow-up did not show mobilization of implants. Discussion. The use of metal porous augments is widely used for severe acetabular defects, being a versatile system to adapt to the different size defects. Nevertheless, its use may be technically demanding and time consuming. It is not infrequent that the setting of the augments conditions the final position of the cup with a possible interference with initial stability and eventually bone ingrowth of the cup. The interlocking mechanism offers an additional biomechanical stability and thus may allow us to place the cup first in the desired position with a less demanding technique. Conclusion With the use of locked-screw porous metal cups, the order of setting of implants may be changed in order to obtain a better restoration of the center of rotation and increased host-bone implant contact with a simplified surgical technique.
Collapse
|
18
|
D’Apolito R, Zagra L. Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes. MATERIALS 2022; 15:ma15103728. [PMID: 35629756 PMCID: PMC9145197 DOI: 10.3390/ma15103728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022]
Abstract
Total hip arthroplasty (THA) is increasingly performed in young patients and the number of revisions is estimated to rise over time. Acetabular osteolysis and bone loss are frequently encountered during revision and may be classified and treated in different ways. Impaction bone grafting (IBG) with morselized allograft offers a viable option. IBG was introduced over 40 years ago in combination with cemented cups, and is also used with uncemented cups. The impacted bone chips act as a void filler to restore bone stock; once incorporated they are substituted by host bone. Surgery entails assessment of the defect, acetabular preparation, preparation of the morselized graft, impaction of the graft, and cup implantation. Satisfactory medium- and long-term results have now been reported in most studies. With the advent of high-porosity cups, indications have been extended, enhancing the potential of IBG, in which primary stability of the cup to the host bone is essential for a successful procedure. Synthetic bone substitutes have also been used in combination with allogenic grafts and may extend the original technique for which long-term studies are warranted.
Collapse
|
19
|
Li C, Wu H, Sun Z, Chen Z, Trampuz A. Global Publication Trends and Research Hotspots of Revision Hip and Knee Arthroplasty: A 21-Year Bibliometric Approach. J Arthroplasty 2022; 37:974-984. [PMID: 35065213 DOI: 10.1016/j.arth.2022.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As the number of primary hip and knee arthroplasties increases, revision cases correspondingly demonstrate high relative growth, gaining increasing attention. The present research aimed to investigate subject characteristics in revision hip and knee arthroplasty (RHKA) research using a bibliometric approach. METHODS Publications related to RHKA from 2000 to 2020 were searched in the Web of Science database. WPS Office, CiteSpace, VOSviewer, and Bibliometrix were used to analyze the results. RESULTS Bibliometric analysis revealed 3290 records. Fifty-nine countries published manuscripts on RHKA. The United States contributed most and also had the highest number of international collaborations. The most relevant institution was the Mayo Clinic. Berry DJ and Parvizi J were the most productive and academic influential authors in RHKA, respectively. The most productive journal was the Journal of Arthroplasty. Co-occurrence analysis demonstrated "infection" to be the trend in RHKA. Thematic analysis displayed 16 keywords in hip arthroplasty and 14 keywords in knee arthroplasty. CONCLUSION The present study observed an increasing trend of research papers in RHKA. Institutions and scholars from the United States were found to dominate the field. Periprosthetic joint infection was likely a potential development trend and hotspot of RHKA.
Collapse
Affiliation(s)
- Cheng Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China; Center for Musculoskeletal Surgery (CMSC), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Haiyang Wu
- Graduate School of Tianjin Medical University, Tianjin, China; Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Zhiming Sun
- Graduate School of Tianjin Medical University, Tianjin, China; Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Zihao Chen
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
20
|
Three-dimensional-printed titanium implants for severe acetabular bone defects in revision hip arthroplasty: short- and mid-term results. INTERNATIONAL ORTHOPAEDICS 2022; 46:1289-1297. [PMID: 35384469 DOI: 10.1007/s00264-022-05390-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 03/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Severe acetabular bone defect is challenging in revision hip arthroplasty. In the present study, we aimed to present new treatment options with the 3D printing technique and analyze the clinical and radiographic outcomes of 3D-printed titanium implants for the treatment of severe acetabular bone defects in revision hip arthroplasty. METHODS A total of 35 patients with Paprosky type 3 bone defect and pelvic discontinuity (PD), who underwent hip revisions using 3D-printed titanium implants between 2016 and 2019 at our institution, were retrospectively reviewed. Patient-specific 3D-printed titanium augments and shells (strategy A) were used in 22 type 3A and two type 3B patients. Custom 3D-printed flanged components (strategy B) were used in 11 type 3B patients, including five PD. The clinical outcomes were evaluated with the Harris hip score (HHS). In addition, radiographic results were analyzed by the hip centre of rotation (V-COR and H-COR), implant failure, and survivorship. RESULTS The mean follow-up was 41.5 months (range, 16-62). The HHS was improved from 47.8 ± 8.2 pre-operatively to 78.1 ± 10.1 at one year follow-up and 86.4 ± 5.1 at the last follow-up (p < 0.01). Post-operative V-COR and H-COR of the operated side were 20.8 ± 2.0 mm and 30.2 ± 1.6 mm compared with 51.4 ± 4.1 mm and 33.9 ± 9.0 mm pre-operatively (p < 0.01). The complications included one dislocation and one partial palsy of the sciatic nerve. At the latest follow-up, no radiological component loosening or screw breakage was present. CONCLUSIONS 3D-printed titanium implants showed satisfactory short- and mid-term clinical and radiographic outcomes. It was an effective therapeutic regimen with a low rate of complications, providing a patient-specific and reliable strategy for the severe acetabular bone defect in revision hip arthroplasty.
Collapse
|
21
|
3D Printing Applications in Orthopaedic Surgery: Clinical Experience and Opportunities. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Three-dimensional (3D) printing is a technology capable of creating solid objects based on the reproduction of computerised images. This technology offers revolutionary impacts on surgical practice, especially in prosthetic and traumatological surgery. Methods: 20 patients with proximal humeral fractures were divided into two groups, one of which involved the processing of a 3D model. The model made it possible to plan the positioning and dimensions of the implants. The results were then compared with those obtained according to the usual procedures. We also reported the irreparable case of a custom revision implants acetabular bone loss treated with a 3D-printed, custom-made implant. Results: In the processed 3D proximal humeral fracture series, in the face of time and costs expenses, surgical and X-ray times were shorter than in the control group. On the other hand, there were no differences in terms of blood loss. The patient who underwent acetabular re-prosthetic surgery in a 3B Paprosky bone loss was managed and solved with a 3D-printed, custom-made implant and reported excellent outcomes at a 1 year follow-up. Conclusion: Three-dimensional printing made it possible to create better pre-operative planning in traumatology in order to optimise surgical procedures and outcomes. It also made it possible to deal with large losses of bone stock in prosthetic revision surgery, even when reconstruction may have appeared impossible with traditional implants.
Collapse
|
22
|
Augustyn A, Stołtny T, Rokicka D, Wróbel M, Pająk J, Werner K, Ochocki K, Strojek K, Koczy B. Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report. Medicine (Baltimore) 2022; 101:e28475. [PMID: 35089189 PMCID: PMC8797610 DOI: 10.1097/md.0000000000028475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation. PATIENT CONCERNS A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method. DIAGNOSES The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum. INTERVENTIONS Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the "hanging hip" was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR. OUTCOMES Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period. LESSONS The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.
Collapse
Affiliation(s)
- Aleksander Augustyn
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| | - Tomasz Stołtny
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| | - Dominika Rokicka
- Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, M. Curie-Skłodowskiej St. 9, Zabrze, Poland
| | - Marta Wróbel
- Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, M. Curie-Skłodowskiej St. 9, Zabrze, Poland
| | - Jan Pająk
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| | - Krystian Werner
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| | - Karol Ochocki
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| | - Krzysztof Strojek
- Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, M. Curie-Skłodowskiej St. 9, Zabrze, Poland
| | - Bogdan Koczy
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Bytomska St. 62, Piekary Śląskie, Poland
| |
Collapse
|
23
|
Innocenti M, Muratori F, Mazzei G, Guido D, Frenos F, Lucenteforte E, Capanna R, Campanacci DA. The use of a non-biological, bridging, antiprotrusio cage in complex revision hip arthroplasty and periacetabular reconstructive oncologic surgery. Is still today a valid option?: A mid/long-term survival and complications' analysis. Arch Orthop Trauma Surg 2022; 142:681-690. [PMID: 34028571 PMCID: PMC8924141 DOI: 10.1007/s00402-021-03929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Burch-Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages' failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked. MATERIALS AND METHODS We evaluated 73 patients who received a B-SlAC from January 2008 to January 2018. Group A, 40 oncological cases (22 primary tumors; 18 metastases); Group B, 33 failed THAs. We compared both Kaplan-Meier estimates of risk of failure and complication with the cumulative incidence function, taking account the competing risk of death. Cox proportional hazards model was utilized to identify possible predictors of instability and infection. Harris hip score HHS was used to record clinical outcomes. RESULTS Medium follow-up was 80 months (24-137). Average final HHS was 61 (28-92), with no differences within the two groups (p > 0.05). The probabilities of failure and complications were 57% and 26%, respectively, lower in the oncologic group than in the rTHA group (p =0 .176; risk 0.43) (p = 0.52; risk 0.74). Extended ileo-femoral approach and proximal femur replacement (p =0.02, risk ratio = 3.2; p = 0.04, rr = 2.1) were two significant independent predictors for dislocations, while belonging to group B (p = 0.04, rr = 2.6) was predictable for infections. CONCLUSION Burch-Schneider-like antiprotrusio cages are a classical non-biological acetabular reconstruction method that surgeons should bear in mind when facing gross periacetabular bone losses, independently of their cause. However, dislocation and infection rates are high. Whenever possible, we suggest preserving the proximal femur in revision THA, and to use a less-invasive postero-lateral approach to reduce dislocation rates in non-oncologic cases.
Collapse
Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Giacomo Mazzei
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Davide Guido
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Ersilia Lucenteforte
- Unit of Medical Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| |
Collapse
|
24
|
Tikhilov RM, Dzhavadov AA, Kovalenko AN, Bilyk SS, Denisov AO, Shubnyakov II. Standard Versus Custom-Made Acetabular Implants in Revision Total Hip Arthroplasty. J Arthroplasty 2022; 37:119-125. [PMID: 34598861 DOI: 10.1016/j.arth.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Today, various options are used for the reconstruction of acetabular bone loss in revision total hip arthroplasty (RTHA). The aim of the study was to compare the outcomes of using standard acetabular implants (SAIs) and custom-made acetabular implants (CMAIs) in RTHA in cases with extensive acetabular bone loss. METHODS This was a comparative analysis of the results of 106 operations of RTHA performed during the period from January 2013 to December 2019. In 61 cases (57.5%), CMAIs were used. In 45 cases (42.5%), SAIs were implanted. RESULTS The incidence of aseptic loosening of the acetabular component after RTHA in uncontained loss of bone stock of the acetabulum (type III-IV as per the Gross and Saleh classification) using the CMAI was less than that using the SAI (2.4% and 10.0%, respectively). The most significant differences in aseptic loosening rates were noted after implantation of the CMAI and SAI in pelvic discontinuity with uncontained bone defect (0% and 60.0%, respectively; P<.001). CONCLUSION The ideal indications for the use of the CMAI are uncontained defects and pelvic discontinuity with uncontained loss of bone stock (types III-V Gross and Saleh classification). Treatment of these defects with the SAI leads to a higher incidence of aseptic loosening requiring re-revisions. Further observation is required to assess the effectiveness of using the CMAI and SAI in the long-term follow-up period.
Collapse
Affiliation(s)
- Rashid M Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alisagib A Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Anton N Kovalenko
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Stanislav S Bilyk
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Alexey O Denisov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Igor I Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| |
Collapse
|
25
|
Pisanu F, Andreozzi M, Fiori E, Altamore F, Bartoli M, Caggiari G, Ortu S, Rios M, Manunta AF, Doria C. Surgical management of hip prosthetic failure in metallosis: A case series and literature review. J Orthop 2021; 28:10-20. [PMID: 34707335 DOI: 10.1016/j.jor.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/21/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022] Open
Abstract
Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis.
Collapse
Affiliation(s)
- Francesco Pisanu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Matteo Andreozzi
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Enrico Fiori
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Fabiana Altamore
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Marco Bartoli
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Sebastiano Ortu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Mario Rios
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Andrea Fabio Manunta
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Carlo Doria
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| |
Collapse
|
26
|
Clinical and radiological survivorship of the Thackray cross plate with rim reinforcement ring for cemented acetabular revision. Arch Orthop Trauma Surg 2020; 140:1825-1835. [PMID: 32852593 DOI: 10.1007/s00402-020-03590-5] [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: 06/01/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acetabular component revision surgery can be a challenging task due to the encountered bone defects. Both cemented and uncemented techniques are described. We report on the survivorship of the Thackray cross plate with rim reinforcement ring for cemented acetabular revision. PATIENTS AND METHODS This is a retrospective case series of all patients treated with the implant with a minimum follow-up of 2 years. Acetabular defects were characterized according to the Paprosky classification. Data on potential risk factors for failure of the construct as well as the Oxford Hip Score (OHS) were collected. Kaplan-Meier survival analysis with radiographic aseptic loosening or revision for aseptic loosening as the end point was performed. RESULTS From 2000 to 2017, 35 revisions in 18 male and 17 female patients with an average age of 72 years were included. Bone allograft was used in 26 cases and additional implants (medial or supero-lateral mesh) in 13. Seven patients have deceased and the fate of all revisions is known. At an average clinical follow-up of 9.7 (2.6 to 19.6) years, there were no further re-revisions for construct failure. Five hips have demonstrated radiological evidence of aseptic loosening. Radiologically loose components were associated with more severe grades of acetabular bone defects (Paprosky Type 3) (60% vs 3%, p = 0.006). Kaplan-Meier survival analysis demonstrates 79.8% overall survivorship at 7 years. Survivorship for Type 2 defects was significantly higher compared to Type 3 (90% vs 0% at 7 years, Logrank test p = 0.002, Cox proportional hazards p = 0.03). The final median OHS was 38 (12-48) and was not affected by component loosening. CONCLUSION This is a cost-effective device that protects the underlying bone graft (81% complete remodeling) and prevents subsidence of the cemented cup (2 mm on average). It should be used with caution in high-grade defects and perhaps not advised.
Collapse
|
27
|
Mancino F, Cacciola G, Di Matteo V, De Marco D, Greenberg A, Perisano C, MA M, Sculco PK, Maccauro G, De Martino I. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8655. [PMID: 32913591 PMCID: PMC7459368 DOI: 10.4081/or.2020.8655] [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: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large "jumbo cups", oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.
Collapse
Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Marco
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malahias MA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
28
|
Affiliation(s)
- Rajesh Malhotra
- All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Raju Vaishya
- Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| |
Collapse
|