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Wang Q, Wang Q, Liu P, Ge J, Zhang Q, Guo W, Wang W. Clinical and radiological outcomes of jumbo cup in revision total hip arthroplasty: A systematic review. Front Surg 2022; 9:929103. [PMID: 36268211 PMCID: PMC9577022 DOI: 10.3389/fsurg.2022.929103] [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: 04/26/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Many studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis. Results A total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm. Conclusion A jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.
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Affiliation(s)
- Qiuyuan Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qi Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Department of Orthopaedic Surgery, Peking University of China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Pei Liu
- Department of Adult Joint Reconstruction, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Zhengzhou, China
| | - Juncheng Ge
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Department of Orthopaedic Surgery, Peking University of China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China,Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Correspondence: Weiguo Wang Wanshou Guo
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China,Correspondence: Weiguo Wang Wanshou Guo
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Jones CW, Choi DS, Sun P, Chiu YF, Lipman JD, Lyman S, Bostrom MPG, Sculco PK. Clinical and design factors influence the survivorship of custom flange acetabular components. Bone Joint J 2019; 101-B:68-76. [PMID: 31146558 DOI: 10.1302/0301-620x.101b6.bjj-2018-1455.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. PATIENTS AND METHODS A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men; their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (sd 27.6; 0 to 116). Two sets of statistical analyses were performed: 1) univariate analyses (Pearson's chi-squared and independent-samples Student's t-tests) for each feature; and 2) bivariable logistic regressions using features identified from a random forest analysis. RESULTS Radiological failure and revision rates were 23% and 12.5%, respectively. Revisions were undertaken at a mean of 25.1 months (sd 26.4) postoperatively. Patients with radiological failure were younger at the time of the initial procedure, were less likely to have a diagnosis of primary osteoarthritis (OA), were more likely to have had ischial screws in previous surgery, had fewer ischial screw holes in their CFAC design, and had more proximal ischial fixation. Random forest analysis identified the age of the patient and the number of locking and non-locking screws used for inclusion in subsequent bivariable logistic regression, but only age (odds ratio 0.93 per year) was found to be significant. CONCLUSION We identified both patient and design features predictive of CFAC survivorship. We found a higher rate of failure in younger patients, those whose primary diagnosis was not OA, and those with more proximal ischial fixation or fewer ischial fixation options. Cite this article: Bone Joint J 2019;101-B(6 Supple B):68-76.
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Affiliation(s)
- C W Jones
- Hospital for Special Surgery, New York City, New York, USA
| | - D S Choi
- Hospital for Special Surgery, New York City, New York, USA
| | - P Sun
- Hospital for Special Surgery, New York City, New York, USA
| | - Y-F Chiu
- Hospital for Special Surgery, New York City, New York, USA
| | - J D Lipman
- Hospital for Special Surgery, New York City, New York, USA
| | - S Lyman
- Hospital for Special Surgery, New York City, New York, USA
| | - M P G Bostrom
- Hospital for Special Surgery, New York City, New York, USA
| | - P K Sculco
- Hospital for Special Surgery, New York City, New York, USA
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Zhou B, Zhou Y, Yang D, Tang H, Shao H, Huang Y. The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study. J Arthroplasty 2018; 33:3724-3733. [PMID: 30243881 DOI: 10.1016/j.arth.2018.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Reconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques. METHODS A retrospective review was conducted on 74 consecutive THAs revised using metal augments with a cementless hemispherical cup and 77 consecutive THAs revised using the jumbo cup, all with a minimum 2-year follow-up. Biomechanical parameters were measured before and immediately after the revision. Radiological and clinical outcomes at follow-ups were also evaluated. RESULTS The metal augment group had a reconstructed center of rotation (COR) that was 6.5 mm closer to the anatomic COR in height (P < .001), had 3.6 m smaller cup size (P < .001), and had 5.7 mm less head-cup difference (P < .001). Moreover, there was a reconstructed COR that was much closer to the anatomic COR (vertical distance: 1.8 vs 14.1 mm, P < .001; horizontal distance: -2.1 vs 7.9 mm, P = .013), had 4.1 mm greater femoral offset (P = .006), and had 8 mm less leg length discrepancy (P = .035) in the subgroup of Paprosky type III bone defects when compared to the jumbo cup group. All cup-augment constructs were radiologically stable with a higher mean postoperative Harris Hip Score (P = .012). One jumbo cup was radiologically unstable. CONCLUSION In revision THA, utilizing metal augments helps to restore the COR position more precisely, avoid using a larger cup, reduce head-cup difference, rebuild femoral offset, and decrease leg length discrepancy, particularly with Paprosky type III bone defects. Moreover, it provides satisfactory radiological and clinical outcomes in the short term.
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Affiliation(s)
- Baochun Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
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Barlow BT, Oi KK, Lee YY, Carli AV, Choi DS, Bostrom MP. Outcomes of Custom Flange Acetabular Components in Revision Total Hip Arthroplasty and Predictors of Failure. J Arthroplasty 2016; 31:1057-64. [PMID: 26742903 DOI: 10.1016/j.arth.2015.11.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/30/2015] [Accepted: 11/16/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Custom triflange acetabular components (CTAC) have become more popular in the treatment of Paprosky type IIIB defects with an average survivorship of 80% at 4 years. Many studies report survivorship of CTAC, but radiographic parameters of CTAC success or failure have not been previously reported. The purpose of the study was to assess radiographic and patient factors predictive of failure in CTAC. METHODS A retrospective review of 63 patients with >24 months of follow-up was completed. Continuous and categorical variables were compared between failed vs successful CTAC using Wilcoxon rank-sum test and Fisher exact test, respectively. RESULTS The failure rate of the CTAC was 13.5% over an average follow-up of 4.32 years (±2.94). Patients had a mean of 2 revisions (range, 0-11) before CTAC implantation. Compared with the contralateral hip center of rotation, the failed CTAC group tended to lateralize the hip center by a mean of 18.29 mm (±11.90 mm) compared to a mean of 9.86 mm (±11.89) in the intact group, although this did not reach statistical significance (P = .1029). The Western Ontario and McMaster Universities Osteoarthritis Index function score improved from 38.94 (±14.23) to 71.35 (±21.96) at most recent follow-up (P = .0002). The Western Ontario and MacMaster Universities Osteoarthritis Index scores were not significantly different between intact and failed CTAC groups. CONCLUSIONS CTAC tends to lateralize the hip center by approximately 1 cm, and there is a trend toward nearly 2 cm of lateralization in the small subset of failed CTAC. Future efforts should focus on medializing the hip center in CTAC to improve ingrowth and survivorship.
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Affiliation(s)
- Brian T Barlow
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Kathryn K Oi
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yuo-Yu Lee
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York
| | - Alberto V Carli
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Daniel S Choi
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Mathias P Bostrom
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Jamieson ML, Russell RD, Incavo SJ, Noble PC. Does an enhanced surface finish improve acetabular fixation in revision total hip arthroplasty? J Arthroplasty 2011; 26:644-8. [PMID: 20647161 DOI: 10.1016/j.arth.2010.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/18/2010] [Indexed: 02/01/2023] Open
Abstract
High-porosity "cancellous metal" coatings have been introduced to increase the fixation and biologic incorporation of acetabular cups. The strength of initial fixation provided by a cancellous metal cups vs conventional alternatives in the deficient revision acetabulum was investigated. Cancellous, plasma-sprayed, and beaded cups (n = 9) were implanted under controlled conditions into a validated model of the revision acetabulum. The greatest differences were seen in resistance to catastrophic (spin-out) failure that, for the cancellous shell, averaged 1076 ± 265 N, which was 25% greater than the plasma-sprayed implant (859 ± 214 N, P = .04) and 218% greater than the beaded implant (338 ± 123 N, P < .01). The cancellous coating also provided greater resistance to ultimate failure. These results suggest that these new cancellous metal coatings may represent a promising alternative for fixation in revision total hip arthroplasty.
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Lakemeier S, Aurand G, Timmesfeld N, Heyse TJ, Fuchs-Winkelmann S, Schofer MD. Results of the cementless Plasmacup in revision total hip arthroplasty: a retrospective study of 72 cases with an average follow-up of eight years. BMC Musculoskelet Disord 2010; 11:101. [PMID: 20507578 PMCID: PMC2887774 DOI: 10.1186/1471-2474-11-101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple revision implant systems currently available for socket revision in revision total hip arthroplasty. Up until now, not all of these systems have been followed up with regards to their long-term use as a revision implantation.For the first time, this study presents the hemispherical porous-coated socket Plasmacup SC, produced by Aesculap, Tuttlingen, Germany, and the clinical and radiological mid-term results of this revision cup implant. METHODS Over a period of ten years the Plasmacup SC press-fit-cup was used as a revision implant in 72 consecutive aseptic cases which were included in this retrospective study. The mean follow-up period was 8 years. Bone graft transplantation was performed in 32% of all cases. In 90%, the cup was fixed with additional screws. The follow-up radiographs were analysed with regards to cup migration, osteointegration and osteolysis in the DeLee zones using a computer aided program taking the teardrop figure as a main point of reference. For clinical evaluation the Harris-Hip-Score and the WOMAC-Score were utilized. RESULTS At the follow up examination, the mean Harris-Hip-Score was 83.5 points and the mean WOMAC-Score 34.7 points. 93% of all patients were satisfied with the result of the operation. No aseptic cup loosening could be observed and only one cup had to be removed due to infection. No significant longitudinal or transversal cup migration could be observed. CONCLUSION Aesculap's Plasmacup SC is suitable as a cementless cup revision implant. There is stable cup osteointegration, post press-fit implantation, even in the case of major acetabular bone defects.
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Affiliation(s)
- Stefan Lakemeier
- Department of Orthopaedics and Rheumathology, Baldingerstrasse, 35043 Marburg, University Hospital Giessen and Marburg, location Marburg, Germany.
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Winkler H. Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft. Int J Med Sci 2009; 6:247-52. [PMID: 19834590 PMCID: PMC2755120 DOI: 10.7150/ijms.6.247] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 09/04/2009] [Indexed: 11/05/2022] Open
Abstract
Infection of a total hip replacement (THR) is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. It is undoubted that one stage exchange, if successful, would provide the best benefit both for the patient and the society. Still the fear of re-infection dominates the surgeons decisions and in the majority of cases directs them to multiple stage protocols. However, there is no scientifically based argument for that practice. Successful eradication of infection with two stage procedures is reported to average 80% to 98%. On the other hand a literature review of Jackson and Schmalzried (CORR 2000) summarizing the results of 1,299 infected hip replacements treated with direct exchange (almost exclusively using antibiotic loaded cement), reports of 1,077 (83%) having been successful. The comparable results suggest, that the major factor for a successful outcome with traditional approaches may be found in the quality of surgical debridement and dead space management. Failures in all protocols seem to be caused by small fragments of bacterial colonies remaining after debridement, whereas neither systemic antibiotics nor antibiotic loaded bone cement (PMMA) have been able to improve the situation significantly. Reasons for failure may be found in the limited sensitivity of traditional bacterial culturing and reduced antibiotic susceptibility of involved pathogens, especially considering biofilm formation. Whenever a new prosthesis is implanted into a previously infected site the surgeon must be aware of increased risk of failure, both in single or two stage revisions. Eventual removal therefore should be easy with low risk of additional damage to the bony substance. On the other hand it should also have potential of a good long term result in case of success. Cemented revisions generally show inferior long term results compared to uncemented techniques; the addition of antibiotics to cement reduces its biomechanical properties. Efficient cementing techniques will result in tight bonding with the underlying bone, making eventual removal time consuming and possibly associated with further damage to the osseous structures. All these issues are likely to make uncemented revisions more desirable. Allograft bone may be impregnated with high loads of antibiotics using special incubation techniques. The storage capacities and pharmacological kinetics of the resulting antibiotic bone compound (ABC) are more advantageous than the ones of antibiotic loaded cement. ABC provides local concentrations exceeding those of cement by more than a 100fold and efficient release is prolonged for several weeks. The same time they are likely to restore bone stock, which usually is compromised after removal of an infected endoprosthesis. ABC may be combined with uncemented implants for improved long term results and easy removal in case of a failure. Specifications of appropriate designs are outlined. Based on these considerations new protocols for one stage exchange of infected TJR have been established. Bone voids surrounding the implants may be filled with antibiotic impregnated bone graft; uncemented implants may be fixed in original bone. Recent studies indicate an overall success rate of more than 90% without any adverse side effects. Incorporation of allografts appears as after grafting with unimpregnated bone grafts. Antibiotic loaded bone graft seems to provide sufficient local antibiosis for protection against colonisation of uncemented implants, the eluted amounts of antibiotics are likely to eliminate biofilm remnants, dead space management is more complete and defects may be reconstructed efficiently. Uncemented implants provide improved long term results in case of success and facilitated re-revision in case of failure. One stage revision using ABC together with uncemented implants such should be at least comparably save as multiple stage procedures, taking advantage of the obvious benefits for patients and economy.
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Affiliation(s)
- Heinz Winkler
- Osteitis Centre, Privatklinik Döbling, HeiligenstaedterStrasse 57-63, A-1190 Vienna, Austria.
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Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg 2008; 128:545-50. [PMID: 18000673 DOI: 10.1007/s00402-007-0501-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Indexed: 02/06/2023]
Abstract
The treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiological outcome of revision THA using jumbo cups for acetabular reconstruction after applying the bone-grafting technique. We studied 17 patients with acetabular defects ranging from Type 2A to Type 3A according to Paprosky's classification. According to the AAOS-score twelve patients were classified as Type II and five patients as Type III. Uncemented press-fit cups with an outer diameter larger than 64 mm were used in all cases. Fifteen patients received morselized bone allografts. In eight patients an additional screw fixation was necessary. The mean follow-up period was 82 months (range 33-149). The mean Harris Hip Score was preoperatively 62 and at the time of the last follow-up examination 83 points (p = 0.007). Two acetabular components failed, one due to aseptic loosening and another one due to septic loosening. There was a trend of displacement of the femoral head centre towards the infero-lateral position after using jumbo cups that approached statistical significance (p = 0.065). Closure of acetabular defects of Types 2A to 3A according to Paprosky's classification and type II to III according to the AAOS-score respectively can be satisfactorily accomplished using jumbo cups after applying the bone-grafting technique.
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Tabutin J, Pelegri C, Cambas PM, Vogt F. [Fence grafting for acetabular reconstruction with a cementless cup]. ACTA ACUST UNITED AC 2006; 92:708-14. [PMID: 17124455 DOI: 10.1016/s0035-1040(06)75932-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acetabular reconstruction is difficult after loss of bone stock and socket remodeling. Several techniques have been proposed ranging from a metal backing to allografting. We propose fence grafting. After explantation, the acetabulum is carefully cleaned of all interface tissue and precisely measured. If the vertical diameter is clearly greater than the anteroposterior diameter, a tricortical graft is harvested from the iliac crest and modeled to perfectly fit between the anterioinferior iliac spine and the residual posterior wall as well as the fundus medially. One or two oblique screws are inserted for stabilization. Any superior bone loss is filled by bone substitute (without mechanical value). The acetabulum is then reamed from the obturator foramen sparing the anterior and posterior columns. Residual bony defects are filled with cancellous bone. A hemispheric cup is then press fit and maintained with two or three screws. We performed this procedure in eight patients with SO.F.C.O.T. stage III acetabular loosening with segmentary bone loss and an oval acetabular cavity. Clinical follow-up was more than four years. The Postel-Merle-d'Aubigné score improved from 9.8 to 15.7 on average. Radiographically, there were no implant mobilization or migration and no circumferential lucent lines were observed. A nearly anatomic position was achieved in all cases except two (technical imperfection). At more than one-year follow-up, the grafts could not be distinguished from adjacent bone. For us, high-positioned or jumbo cups do not offer a satisfactory reconstruction option. There is a risk of compression with allografts from a head bank. We have not used the cemented metal-backed solution nor impacted grafts. The major drawback with fence grafting is the iliac harvesting (possible residual limping because of the extensive disinsertion of the gluteus medius. The reliable acetabular reconstruction is the major advantage. This technique is not simply an acetabular block widened laterally but it decreases the vertical dimension. This is a reliable but minute technique which allows true long-lasting reconstruction of the acetabulum.
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Affiliation(s)
- J Tabutin
- Centre Hospitalier de Cannes, 15, avenue Broussailles, 06401 Cannes Cedex.
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