1
|
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
|
2
|
Li G, Zhang X, Chen M, Luo Z, Ji X, Pan C, Li H, Shang XF. Bispherical metal augment improved biomechanical stability in severe acetabular deficiency reconstruction: a comparative finite element analysis. BMC Musculoskelet Disord 2024; 25:691. [PMID: 39217319 PMCID: PMC11365125 DOI: 10.1186/s12891-024-07816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/17/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study used finite element analysis (FEA) to compare the biomechanical stability of bispherical metal augment (BA) and wedge-shaped trabecular-metal augment (TA) in different acetabular defect reconstruction models, thereby explaining the application value of this novel bispherical augment in complex hip revision. METHODS Three different acetabular defect pelvis models originating from three representative patients with different types of severe acetabular defects (Paprosky IIC, IIIA, and IIIB) were constructed and reconstruction with BA and TA technique was simulated. Based on the FEA models, the displacement of reconstruction implants, relative displacement of bone implants, and hemi-pelvic von Mises stress were investigated under static loads. RESULTS BA acquired smaller reconstruction system displacement, less relative displacement of bone implants, and lower pelvic von Mises stress than TA in all Paprosky IIC, IIIA, and IIIB defect reconstructions. CONCLUSION The FEA results show that BA could acquire favourable biomechanical stability in severe acetabular defect reconstruction. This technique is a reliable method in complex hip revision.
Collapse
Affiliation(s)
- Guoyuan Li
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Xiaoqi Zhang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Min Chen
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Zhengliang Luo
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Xiaofeng Ji
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China
| | - Chunang Pan
- Beijing Engineering and Technology Research Center for Medical Endoplant, Beijing, 100000, People's Republic of China
- Beijing Naton Medical Technology Holdings Co. Ltd, Beijing, 100000, People's Republic of China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplant, Beijing, 100000, People's Republic of China
- Beijing Naton Medical Technology Holdings Co. Ltd, Beijing, 100000, People's Republic of China
| | - Xi-Fu Shang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, 17 Lujiang Road, Hefei, 230000, People's Republic of China.
| |
Collapse
|
3
|
Nimmal Haribabu G, Basu B. Implementing Machine Learning approaches for accelerated prediction of bone strain in acetabulum of a hip joint. J Mech Behav Biomed Mater 2024; 153:106495. [PMID: 38460455 DOI: 10.1016/j.jmbbm.2024.106495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
The Finite Element (FE) methods for biomechanical analysis involving implant design and subject parameters for musculoskeletal applications are extensively reported in literature. Such an approach is manually intensive and computationally expensive with longer simulations times. Although Artificial Intelligence (AI) based approaches are implemented to a limited extent in biomechanics, such approaches to predict bone strain in acetabulum of a hip joint, are hardly explored. In this context, the primary objective of this paper is to evaluate machine learning (ML) models in tandem with high-fidelity FEA data for the accelerated prediction of the biomechanical response in the acetabulum of the human hip joint, during the walking gait. The parameters used in the FEA study included the subject weight, number and distribution of fins on the periphery of the acetabular shell, bone condition and phases of the gait cycle. The biomechanical response has also been evaluated using three different acetabular liners, including pre-clinically validated HDPE-20% HA-20% Al2O3, highly-crosslinked ultrahigh molecular weight polyethylene (HC-UHMWPE) and ZrO2-toughened Al2O3 (ZTA). Such parametric variation in FEA analysis, involving 26 variables and a full factorial design resulted in 10,752 datasets for spatially varying bone strains. The bone condition, as opposed to subject weight, was found to play a statistically significant role in determining the strain response in the periprosthetic bone of the acetabulum. While utilising hyperparameter tuning, K-fold cross validation and statistical learning approaches, a number of ML models were trained on the FEA dataset, and the Random Forest model performed the best with a coefficient of determination (R2) value of 0.99/0.97 and Root Mean Square Error (RMSE) of 0.02/0.01 on the training/test dataset. Taken together, this study establishes the potential of ML approach as a fast surrogate of FEA for implant biomechanics analysis, in less than a minute.
Collapse
Affiliation(s)
- Gowtham Nimmal Haribabu
- Laboratory for Biomaterials Science and Translational Research, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials Science and Translational Research, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India.
| |
Collapse
|
4
|
刘 懿, 李 叔, 程 奇, 穆 杰. [Advances in revision surgery after primary total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1548-1555. [PMID: 38130200 PMCID: PMC10739673 DOI: 10.7507/1002-1892.202309016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
Objective To review research advances of revision surgery after primary total hip arthroplasty (THA) for patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods The recent literature on revision surgery after primary THA in patients with Crowe type Ⅳ DDH was reviewed. The reasons for revision surgery were analyzed and the difficulties of revision surgery, the management methods, and the related prosthesis choices were summarized. Results Patients with Crowe type Ⅳ DDH have small anteroposterior diameter of the acetabulum, large variation in acetabular and femoral anteversion angles, severe soft tissue contractures, which make both THA and revision surgery more difficult. There are many reasons for patients undergoing revision surgery after primary THA, mainly due to aseptic loosening of the prosthesis. Therefore, it is necessary to restore anatomical structures in primary THA, as much as possible and reduce the generation of wear particles to avoid postoperative loosening of the prosthesis. Due to the anatomical characteristics of Crowe type Ⅳ DDH, the patients have acetabular and femoral bone defects, and the repair and reconstruction of bone defects become the key to revision surgery. The acetabular side is usually reconstructed with the appropriate acetabular cup or combined metal block, Cage, or custom component depending on the extent of the bone defect, while the femoral side is preferred to the S-ROM prosthesis. In addition, the prosthetic interface should be ceramic-ceramic or ceramic-highly cross-linked polyethylene wherever possible. Conclusion The reasons leading to revision surgery after primary THA in patients with Crowe type Ⅳ DDH and the surgical difficulties have been clarified, and a large number of clinical studies have proposed corresponding revision modalities based on which good early- and mid-term outcomes have been obtained, but further follow-up is needed to clarify the long-term outcomes. With technological advances and the development of new materials, personalized prostheses for these patients are expected to become a reality.
Collapse
Affiliation(s)
- 懿 刘
- 吉林大学白求恩第一医院骨科中心骨关节外科(长春 130012)Department of Orthopedic Center, Bethune First Hospital of Jilin University, Changchun Jilin, 130012, P. R. China
| | - 叔强 李
- 吉林大学白求恩第一医院骨科中心骨关节外科(长春 130012)Department of Orthopedic Center, Bethune First Hospital of Jilin University, Changchun Jilin, 130012, P. R. China
| | - 奇胜 程
- 吉林大学白求恩第一医院骨科中心骨关节外科(长春 130012)Department of Orthopedic Center, Bethune First Hospital of Jilin University, Changchun Jilin, 130012, P. R. China
| | - 杰 穆
- 吉林大学白求恩第一医院骨科中心骨关节外科(长春 130012)Department of Orthopedic Center, Bethune First Hospital of Jilin University, Changchun Jilin, 130012, P. R. China
| |
Collapse
|
5
|
Wood MJ, Al-Jabri T, Zaghloul A, Lanting B, Giannoudis PV, Hart AJ. Periprosthetic acetabular fractures as a complication of total hip arthroplasty. Injury 2023; 54:111058. [PMID: 37748235 DOI: 10.1016/j.injury.2023.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty.
Collapse
Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ahmed Zaghloul
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alister James Hart
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, HA7 4LP, United Kingdom
| |
Collapse
|
6
|
Karia M, Boughton O, Mohan SV, Halewood C, Wozencroft R, Clarke S, Cobb J. Enhancing acetabular reaming accuracy: optimal techniques and a novel reamer design. J Orthop Surg Res 2023; 18:583. [PMID: 37553588 PMCID: PMC10408067 DOI: 10.1186/s13018-023-03888-1] [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: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Successful press-fit implantation relies on an accurately reamed bone cavity. Inaccurate reaming can lead to a suboptimal press-fit risking fracture and cup deformation or excessive micromotion and loosening. Several factors may impact reaming accuracy including the reamer design, the surgeon's technique and the bone quality. The aim of this study is to investigate the accuracy of reaming techniques and the accuracy of a novel reamer design. METHODS Eighty composite bone models, half high density and half low density, were reamed with either a conventional or an additively manufactured reamer with a novel design employing either a straight or 'whirlwind' reaming technique. Reamed cavities were scanned using a 3D laser scanner and the median difference between achieved and expected diameters compared. RESULTS The novel reamer design was more accurate than the unused conventional reamer, using both whirlwind (0.1 mm (IQR 0-0.2) vs. 0.3 mm (IQR 0.3-0.4); p < 0.001) and straight techniques (0.3 mm (IQR 0.1-1.0) vs. 1.2 mm (IQR 1-1.6); p = 0.001). Whirlwind reaming was more accurate than straight reaming using both conventional (0.3 mm (IQR 0.3-0.4) vs. 1.2 mm (IQR 1-1.6); p < 0.0001) and single use reamers (0.1 mm (IQR 0-0.2) vs. 0.3 mm (IQR 0.1-1.0); p = 0.007). Reaming errors were higher in low-density bone compared to high-density bone, for both reamer types and reaming techniques tested (0.6 mm (IQR 0.3-1.5) vs. 0.3 mm (IQR 0.1-0.8); p = 0.005). CONCLUSION We present a novel reamer design that demonstrates superior accuracy to conventional reamers in achieving the desired reaming diameter. Improved reaming accuracy was also demonstrated using both devices and in both bone models, using a 'whirlwind' technique. We recommend the use of this novel reamer design employing a 'whirlwind' technique to optimize reaming accuracy. Particular attention should be paid toward patients with lower bone quality which may be more susceptible to higher inaccuracies.
Collapse
Affiliation(s)
- Monil Karia
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK.
| | - Oliver Boughton
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Sceyon Vishnu Mohan
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Camilla Halewood
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Rob Wozencroft
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Susannah Clarke
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| | - Justin Cobb
- MSk Lab, Imperial College London, 2nd Floor, Sir Michael Uren Hub, 86 Wood Lane, London, W12 0BZ, UK
| |
Collapse
|
7
|
Hao L, Zhang Y, Bian W, Song W, Li K, Wang N, Wen P, Ma T. Standardized 3D-printed trabecular titanium augment and cup for acetabular bone defects in revision hip arthroplasty: a mid-term follow-up study. J Orthop Surg Res 2023; 18:521. [PMID: 37481549 PMCID: PMC10362760 DOI: 10.1186/s13018-023-03986-0] [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: 12/27/2022] [Accepted: 07/07/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility and outcomes of standardized three-dimensional (3D)-printed trabecular titanium (TT) cups and augments to reconstruct most acetabular defects. METHODS We included 58 patients with Paprosky type II and III acetabular bone defects who underwent revision hip arthroplasty between 2015 and 2018. Patients who were revised without 3D-printed augments, and cases who were lost to follow-up and died during follow-up were excluded. Radiographic and clinical outcomes were evaluated. A Kaplan-Meier survivorship curve was generated. The mean follow-up was 64.5 (range 49-84) months. RESULTS In total, 48 (82.8%) acetabular revisions were performed using standardized 3D-printed TT cups and augments, and a retrospective review was conducted on 43 revisions. The average position of the vertical center of rotation and leg length discrepancy were significantly decreased from 42.4 ± 9.1 mm and 38.4 ± 10.7 mm to 22.8 ± 3.4 mm and 4.1 ± 3.0 mm, respectively. Non-progressive radiolucent lines were observed in 3 (7.5%) acetabular components with no indications for revision. The mean Harris hip score, Oxford hip score and EuroQol five-dimensional questionnaire score increased from 33.0 ± 10.7, 11.4 ± 3.4 and 0.29 ± 0.09 to 80.3 ± 8.8, 35.8 ± 2.4 and 0.71 ± 0.10, respectively. The revision-free survival rate of the acetabular component was 93.0% (40/43), with a rate of revision for aseptic loosening of 2.3% (1/43). CONCLUSION Standardized 3D‑printed TT augments and cups could be used to reconstruct the majority of Paprosky type II and III acetabular defects in revision hip arthroplasty and demonstrated encouraging results at mid-term follow-up.
Collapse
Affiliation(s)
- Linjie Hao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China
| | - Weiguo Bian
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Wei Song
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China
| | - Kun Li
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China
| | - Nengjun Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China
| | - Pengfei Wen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China.
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, 710000, Shaanxi, China.
| |
Collapse
|
8
|
Dóczi MO, Sződy R, Zwierczyk PT. Extended mechanical loads for the analysis of acetabular cages. Biomech Model Mechanobiol 2023:10.1007/s10237-023-01728-z. [PMID: 37266733 PMCID: PMC10366256 DOI: 10.1007/s10237-023-01728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
To analyse the strength and mechanical behaviour of hip implants, it is essential to employ an appropriate loading model. Generating computational models supplemented with muscle forces is a complicated task, especially in the initial phase of implant development. This research aims to expand the possibilities of the simpler acetabular cage model based on joint loads without significantly increasing the demand for computing resources. A Python script covered and grouped the loads from daily activities. The ten calculated major loads were compared with the maximum of the walking and stair climbing loads through the finite element analyses of a custom-made acetabular cage. Sensitivity analyses were performed for the surrounding bones' elastic modulus and the pelvis boundary conditions. The major loads can geometrically cover the entire load spectrum of daily activities. The effect of many high-magnitude force vectors is uncertain in the approach that uses the most common maximum loads. Using these resultant major loads, a new stress concentration area could be detected on the acetabular cage, besides the stress concentration areas induced by the loads reported in the literature. The qualitative correctness of the results is also supported by a control computed tomography scan: a fracture occurred in an extensive, high-stress zone. The results are not sensitive to changes in the elastic modulus of the surrounding bone and the boundary conditions of the model. The presented load vectors and the algorithm make more extensive static analyses possible with little computational overhead. The proposed method can be used for checking the static strength of similar implants.
Collapse
Affiliation(s)
- Martin O Dóczi
- Department of Machine and Product Design, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3., Budapest, H-1111, Hungary.
| | - Róbert Sződy
- Dr. Manninger Jenő Trauma Center, Fiumei út 17., Budapest, H-1081, Hungary
| | - Péter T Zwierczyk
- Department of Machine and Product Design, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3., Budapest, H-1111, Hungary
| |
Collapse
|
9
|
Dóczi MO, Sződy R, Zwierczyk PT. Equivalent loads from the life-cycle of acetabular cages in relation to bone-graft transformation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 236:107564. [PMID: 37116425 DOI: 10.1016/j.cmpb.2023.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/06/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Bone grafts placed behind acetabular cages change their structure in response to mechanical stimuli. The full consideration of lifestyle loads is extremely resource-intensive, so a method using substitutive loads was proposed to reduce the calculation cost. The aim of the study is to present and prove this method. METHODS By means of mechanical equations and using the force vectors from the literature which have the same initial point and their relative frequency, while applying a linear model, the average strain energy density distribution for all load cases can be calculated, compiling a matrix from the external loads. From the elements of this matrix, three substitutive load vectors can be calculated, which can be proven to produce the same strain energy density distribution by averaging their effects. The feasibility of using this to model the transformation of bone grafts placed behind acetabular cages is demonstrated with a finite element model, along with a reference calculation. RESULTS The substitutive load vectors could be calculated in closed form and the simulations showed that they produced a similar density distribution to the reference model with a numerical calculation error range. Accordingly, the density distribution calculated from bone graft transformation is almost the same. CONCLUSIONS In addition to the aforementioned linearity and the same initial point limitations, the applied method is able to produce the substitutive load vectors with which the calculation of the strain energy density distribution and the bone graft's new density distributions can be carried out faster.
Collapse
Affiliation(s)
- Martin O Dóczi
- Department of Machine and Product Design, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3., Budapest H-1111, Hungary.
| | - Róbert Sződy
- Dr. Manninger Jenő Trauma Center, Fiumei út 17, Budapest H-1081, Hungary
| | - Péter T Zwierczyk
- Department of Machine and Product Design, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Műegyetem rkp. 3., Budapest H-1111, Hungary
| |
Collapse
|
10
|
Total Hip Arthroplasty in Patients With Post-Traumatic Bone Defects and Acetabular Deformities. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Backround. Total hip replacement in cases of traumatic changes of the acetabulum refers to cases of difficult primary arthroplasty and requires detailed preoperative planning and accurate restoration of anatomical relationships in the operated joint.
The aim of the study was to evaluate the structure of pathological changes in the acetabulum in patients with posttraumatic hip arthrosis, to develop a method for their detailed description and to determine the tactics of choosing the type of acetabulum implant.
Methods. The results of treatment of 194 patients with the consequences of acetabulum fractures who underwent total hip arthroplasty in the period from 2014 to 2022 were analyzed. The study was conducted in two stages, at the first stage, the structure of pathological changes, such as defect, deformation, changes in the center of rotation and offset (relatively healthy contralateral joint), was analyzed. A method was developed for choosing the tactics of implantation of the acetabulum component, based on a detailed description of the defect and deformation of the acetabulum. The second stage analyzed the results of treatment of patients for whom planning and surgical treatment was carried out in the period from 2020 to 2022 using the proposed method.
Results. During the first stage of the study, it was revealed that the magnitude of the change in the indicators of the displacement of the rotation center and offset changes by more than 8 mm. statistically significantly increases the likelihood of complications by 17.9%. The restoration of the rotation and offset center reduces the number of complications by 22.3%. The proposed method makes it possible to statistically reliably restore anatomical relationships in the operated hip joint and reduce the number of complications by 10%.
Conclusion. The proposed method allows us to qualitatively and quantitatively describe pathological changes in the bone tissue of the acetabulum. Depending on the degree of displacement of the center of rotation, the walls of the acetabulum and the nature of the defect of the supporting bone tissue, the surgeon can determine the tactics of surgical treatment.
Collapse
|
11
|
Janko M, Verboket R, Genari M, Frank J, Marzi I. Primary or revision arthroplasty with an integrated acetabular cup-MUTARS ® RS cup system. Eur J Trauma Emerg Surg 2022; 48:4149-4155. [PMID: 35357517 PMCID: PMC9532320 DOI: 10.1007/s00068-022-01956-5] [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: 10/21/2021] [Accepted: 03/13/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this article is to show a new concept of indication and application of the MUTARS® RS Cup System in primary and revision hip arthroplasty. This integrated system is applicable for different acetabular cup replacements in patients with acetabular fractures or instable defects, as well as periprosthetic acetabular fractures. The MUTARS® RS Cup System is a cementless revision cup for insertion into the acetabulum with an integrated polyethylene cup, which fits to a regular or bipolar head. This system replaces the conventional approach for acetabular revision with a Burch-Schneider ring, in which a normal polyethylene cup is cemented. This interface with its complications is avoided with this system of a titanium revision cup with integrated polyethylene cup. Steps of preoperative planning and the intraoperative implementation will be highlighted in this article. MATERIAL AND METHODS This system was applied in 49 patients with 52 MUTARS® RS Cup Implantations in 30 males, 22 females, with an average age of 76,1 years (36,9-94,4 years). RESULTS AND DISCUSSION The system shows a good operative feasibility, as well as a reliable handling and safe method for stable treatment of non-reconstructable acetabular fractures or acetabular incongruencies and instabilities.
Collapse
Affiliation(s)
- Maren Janko
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
| | - René Verboket
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Maria Genari
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| |
Collapse
|
12
|
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
|
13
|
Evaluation of the feasibility of acetabular cup pre-determination in revision total hip arthroplasty via X-ray of the bone stock of the anterosuperior acetabulum. J Orthop Surg Res 2021; 16:597. [PMID: 34649561 PMCID: PMC8515768 DOI: 10.1186/s13018-021-02745-3] [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: 06/21/2021] [Accepted: 09/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was aimed to explore (1) location on AP pelvic X-ray that displayed bone stock in anterosuperior acetabulum; (2) whether X-ray could provide enough evidence to evaluate whether bone stock could provide support for acetabular cup; (3) criteria to determine whether anterosuperior bone stock could provide sufficient support for cup on X-ray. Methods Our study retrospectively collected 43 patients who underwent revision THA for cup loosening from 2014 to 2019. The position of anterosuperior acetabular bone stock was compared between X-ray and CT-based 3-D reconstruction. Seventy-millimeter acetabular cup was implanted simulatively to obtain the contact line between acetabular cup and superolateral remaining bone stock. The contact line length and the angle were measured. Patients were divided into cup group and cage group, and ROC curves of both contact line length and angle were drawn. Results The superolateral part of acetabulum on X-ray could reflect the anterosuperior host bone stock of acetabulum according to the comparison of anteroposterior pelvic X-ray and 3-D reconstruction. Critical point was chosen when we got the highest sensitivity with a 100% specificity in ROC curves. The critical values of contact length and angle were 15.58 mm and 25.5°. Conclusions Surgeons could assess the anterosuperior bone stock of acetabulum by AP pelvic X-ray to decide whether revision could be done merely using cup or need customized cage. Clinically, when contact line length was larger than 16 mm or contact angle was larger than 25.5°, adoption of cup could obtain primary stability in the revision surgery in most cases.
Collapse
|
14
|
Vles G, Simmonds L, Roussot M, Volpin A, Haddad F, Konan S. The majority of conversion total hip arthroplasties can be considered primary replacements - a matched cohort study. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The success of conversion Total Hip Arthroplasty (THA) among primary THA and revision THA re- mains unclear. We hypothesized that most conversion THAss can be performed using primary implants and will have an uncomplicated post-operative course. Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2006-2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Data was collected on implants used, major complications, and mortality. PROMs used included the Western Ontario and McMaster Osteoarthritis Index, Harris Hip Score, Visual Analogue Scale and the EQ-5D Health Questionnaire. Seventy- two percent of patients who underwent conversion THA were treated with primary implants and never suffered from a major complication. PROMs were excellent for this group of patients. The distinction primary / conversion / revision THA could not explain differences in outcomes, however the necessity of using revision implants and the development of major complications could. The majority of conversion total hip arthroplasties can be considered a primary replacement. Predicting outcomes for THA should focus on patient frailty and technical difficulties dealing with infection, stability and loss of bone stock and should discard the conversion versus revision terminology.
Collapse
|
15
|
Siegel MA, Patetta MJ, Chen JY, Barragan Echenique DM, Gonzalez MH. The use of a triflange salvage system for catastrophic pelvic osteolysis after failed total hip arthroplasty. J Orthop 2021; 25:16-22. [PMID: 33897135 DOI: 10.1016/j.jor.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022] Open
Abstract
Introduction The custom triflange acetabular implant (CTAI) has been described to address catastrophic pelvic osteolysis, but long-term outcome data is scarce. Methods Revision-free survivorship after revision THA with a CTAI was retrospectively reviewed in seven patients. Results Mean and median follow-up time were 7.39 (1.61-16.8) years and 7.50 years, respectively. Revision-free survivorship was 85.7% (6/7). One patient underwent revision for recurrent dislocations. All patients were able to ambulate at recent follow-up- 2/7 without assistance. Conclusions The CTAI is a viable option for patients with catastrophic pelvic osteolysis. There is a high complication rate, but the incidence of revision is low.
Collapse
Affiliation(s)
- Matthew A Siegel
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | - Michael J Patetta
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | - Jason Y Chen
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| | | | - Mark H Gonzalez
- University of Illinois College of Medicine at Chicago, Department of Orthopaedic Surgery, USA
| |
Collapse
|
16
|
Aharram S, Yahyaoui M, Amghar J, Daoudi A, Agoumi O. The majority of conversion total hip arthroplasties can be considered a primary replacement: a matched cohort study. Eur J Med Res 2020; 25:69. [PMID: 33308313 PMCID: PMC7731546 DOI: 10.1186/s40001-020-00467-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background and study aims The success of conversion total hip arthroplasty (THA) among primary THA and revision THA remains unclear. We hypothesized that most conversion THA’s can be performed using primary implants and will have an uncomplicated post-operative course. Materials and methods Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2008–2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Data were collected on implants used, major complications, and mortality. PROMs used included the Western Ontario and McMaster Osteoarthritis Index, Harris Hip Score, Visual Analogue Scale and the EQ-5D Health Questionnaire. Results Seventy-two percent of patients who underwent conversion THA were treated with primary implants and never suffered from a major complication. PROMs were excellent for this group of patients. The distinction primary/conversion/revision THA could not explain differences in outcomes; however, the necessity of using revision implants and the development of major complications could. Conclusions The majority of conversion total hip arthroplasties can be considered a primary replacement. Predicting outcomes for THA should focus on patient frailty and technical difficulties dealing with infection, stability and loss of bone stock and should discard the conversion versus revision terminology.
Collapse
Affiliation(s)
- Soufiane Aharram
- Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049, Oujda, Morocco. .,Faculty of Medicine and Pharmacy of Oujda, Department of Traumatology Orthopeadic Surgery, CHU Mohammed VI, Oujda University, BP 4806, 60049, Oujda, Morocco.
| | - Mounir Yahyaoui
- Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049, Oujda, Morocco.,Faculty of Medicine and Pharmacy of Oujda, Department of Traumatology Orthopeadic Surgery, CHU Mohammed VI, Oujda University, BP 4806, 60049, Oujda, Morocco
| | - Jawad Amghar
- Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049, Oujda, Morocco.,Faculty of Medicine and Pharmacy of Oujda, Department of Traumatology Orthopeadic Surgery, CHU Mohammed VI, Oujda University, BP 4806, 60049, Oujda, Morocco
| | - Abdelkarim Daoudi
- Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049, Oujda, Morocco.,Faculty of Medicine and Pharmacy of Oujda, Department of Traumatology Orthopeadic Surgery, CHU Mohammed VI, Oujda University, BP 4806, 60049, Oujda, Morocco
| | - Omar Agoumi
- Department of Trauma and Orthopaedics, University Mohammed Premier Oujda, Mohammed VI Oujda Morocco Hospital Center, Oujda University, BP 4806, 60049, Oujda, Morocco.,Faculty of Medicine and Pharmacy of Oujda, Department of Traumatology Orthopeadic Surgery, CHU Mohammed VI, Oujda University, BP 4806, 60049, Oujda, Morocco
| |
Collapse
|
17
|
Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res 2020; 38:2640-2648. [PMID: 32427351 DOI: 10.1002/jor.24752] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
We report on the accuracy, measured with three-dimensional (3D) computed tomography (CT) postoperatively, in positioning custom 3D printed titanium components in patients with large acetabular defects. Twenty patients (13 females and 7 males) received custom-made acetabular implants between 2016 and 2018; the mean age was 66 years (SD = 11.6) and their mean body mass index was 28 (SD = 6.1). The median time to follow up was 25.5 months, range: 12 to 40 months. We describe a comparison method that uses the 3D models of CT-generated preoperative plans and the postoperative CT scans to quantify the discrepancy between planned and achieved component positions. Our primary outcome measures were the 3D-CT-measured difference between planned and achieved a component position in six degrees of freedom: center of rotation (CoR), component rotation, inclination (INC), and version (VER) of the cup. Our secondary outcome measures were: Oxford hip score, walking status, and complication rate. All components (100%) were positioned within 10 mm of planned CoR (in the three planes). Eighteen (95%) components were not rotated by more than 10° compared to the plan. Eleven (58%) components were positioned within 5° of planned cup angle (INC and VER). To date one complication has occurred, a periprosthetic fracture. This is the largest study in which postoperative 3D-CT measurements and clinical outcomes of custom-made acetabular components have been assessed. Accurate pre-op planning and the adoption of custom 3D printed implants show promising results in complex hip revision surgery.
Collapse
Affiliation(s)
- Matthieu Durand-Hill
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | | | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London.,Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
18
|
Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Print Med 2020; 6:23. [PMID: 32845428 PMCID: PMC7450581 DOI: 10.1186/s41205-020-00074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D Printed custom-made implants constitute a viable option in patients with acetabular Paprosky III defects. In these patients, needing complex hip revision surgery, the appreciation of the bony defect is crucial to assure stable fixation of the customised implant, often intended to replace a failed one. We aimed to understand the effect of metal artefact on the design of customised implants. METHODS 26 patients with massive acetabular defects were referred, between May 2016 and September 2018, to our institution classified as "un-reconstructable" by other hospitals. They all received custom 3D-printed acetabular cups. A subset of them underwent two-stage revision surgery due to infection. We then extended the two-stage procedure to the cases where metal artefacts were significantly affecting the reading of the CT scans. CT scans of patients' pelvises were taken pre and post-implant removal. We assessed for changes in bony shape and volume of the pelvis using 3D imaging software and quantified the effect on implant design with CAD software. RESULTS Eight (out of 26) patients (31%) underwent two-stage revision surgery. The CT bony reconstructions between the two timepoints changed in all cases. The changes were mostly associated to the shape and distribution of the acetabular defects. Three of these cases (37.5%) showed a remarkable difference in the remaining bone that led to a change in implant design. So far, there has been no difference in the clinical outcome between the patients who underwent single (n = 18) and two-stage surgery (n = 8). CONCLUSIONS The shape of the acetabulum reconstructed from CT data is potentially altered by metal artefact and bone excised during removal of the failed component. For "end-of-road" acetabular reconstruction, we recommend surgeons consider the use of two-stage surgery to enable a reliable fitting of the complex shape of 3D-printed implants.
Collapse
Affiliation(s)
- Anna Di Laura
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
| | - Robert Wescott
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Alister J. Hart
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| |
Collapse
|
19
|
Tikhilov RM, Shubnyakov II, Denisov AO. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases). TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2019. [DOI: 10.21823/2311-2905-2019-25-1-122-141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R. M. Tikhilov
- Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University
| | - I. I. Shubnyakov
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - A. O. Denisov
- Vreden Russian Research Institute of Traumatology and Orthopedics
| |
Collapse
|
20
|
Zhang Y, Zhang L, Sun R, Jia Y, Chen X, Liu Y, Oyang H, Feng L. A new 3D printed titanium metal trabecular bone reconstruction system for early osteonecrosis of the femoral head. Medicine (Baltimore) 2018; 97:e11088. [PMID: 29952948 PMCID: PMC6039592 DOI: 10.1097/md.0000000000011088] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Presently, biomechanical support therapy for the femoral head has become an important approach in the treatment of early osteonecrosis of the femoral head (ONFH). Previous studies have reported that the titanium metal trabecular bone reconstruction systems (TMTBRS) achieved satisfactory clinical results for the treatment of early femoral head necrosis. Electron beam melting technology (EBMT) is an important branch of 3D printing technology, which enables the construction of an interface that is required for support of bone in-growth. However, the effect of TMTBRS created using EBMT for clinical applications for early ONFH is still unknown. At present, there are no reports on this topic worldwide. The purpose of this study was to assess the safety of a new 3D printed TMTBRS implant and to evaluate its clinical efficacy in early ONFH.Thirty patients who underwent surgery for ONFH were selected. The stages of ONFH were classified according to the Association Research Circulation Osseus (ARCO) classification. They were followed-up and radiological examination was performed at 6, 12, and 24 months post-surgery to assess TMTBRS stability and bone growth in the bone trabecular holder portion surface. To evaluate hip function, postoperative Harris and Visual Analogue Scale (VAS) scores were used.The postoperative Harris score increased significantly and VAS score decreased significantly at the 12-month follow-up compared to the 24-month follow-up, wherein the Harris score declined slightly and the VAS score was slightly elevated with the aggravation of ONFH. With the passage of time, postoperative improvement rates were 100% for IIA, 70% for IIB, and 0% for IIC. Hip-preserving rates were 100% for IIA, 100% for IIB, and 50% for IIC.The effect of TMTBRS treatment for early ONFH in ARCO IIA and ARCO IIB is satisfactory. However, it is not recommended for a relatively large area of necrosis such as in ARCO IIC.
Collapse
Affiliation(s)
- Ying Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Leilei Zhang
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Ruibo Sun
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Yudong Jia
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Xiantao Chen
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Youwen Liu
- Medical Center of Hip, Luoyang Orthopedic-Traumatological Hospital, Orthopedics Hospital of Henan Province, Luoyang
| | - Hong Oyang
- Beijing TianXinFu Medical Appliance Co, Beijing
| | - Lizhi Feng
- The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| |
Collapse
|
21
|
Determination of structural femoral head allograft viability and integrity with a novel diagnostic tool: SPECT/CT. A preliminary study. Hip Int 2017; 27:558-563. [PMID: 28605001 DOI: 10.5301/hipint.5000502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the viability and integrity of fresh frozen bulk femoral head allografts obtained from the institutional bone bank that were used to reconstruct severe acetabular defects and to validate the SPECT/CT method which gives both anatomical and functional data for this purpose. METHODS We retrospectively reviewed 9 patients (6 female, 3 male; mean age 63.6 years). Preoperative and postoperative leg lengths, existence of the Trendelenburg sign, range of motion of the hip, visual analogue score (VAS), Harris Hip Score (HHS) and any complication were assesed at each follow-up. Radiographically, position of the cup, signs of loosening or migration, and union of the graft were all determined. At the latest follow-up, patients were evaluated with hybrid SPECT/CT. RESULTS The average duration of follow-up was 38.1 months (24-50 months). The overall mean HHS and VAS scores were significantly improved (p<0.05). When hybrid SPECT/CT results were evaluated, the vascular phase of scintigraphy showed hyperaemia of the graft and the bone phase of scintigraphy showed normal or increased radiotracer uptake in the graft site in 7 patients. SPECT/CT images were used to determine the exact localisation of osteoblastic activity. 1 patient with minor resorption of the graft without clinical symptoms revealed mild osteoblastic activity. The patient who had no activity in the graft site was rerevised because of infection. CONCLUSIONS Institutional bank allografts are still excellent options for treating large acetabular defects in revision total hip arthroplasty where trabecular metals are not available or in common use. The Hybrid SPECT/CT method is a reliable, noninvasive method for evaluating both the integrity and viability of a bulk graft in 3-D.
Collapse
|