Acetabular reconstruction for primary and revision total hip arthroplasty using Kerboull-type acetabular reinforcement devices-case-control study with factors related to poor outcomes of surgery

Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty

BACKGROUND

This study compared the re-revision rate and radiographic outcomes of revision total hip arthroplasty (THA) using a Kerboull-type acetabular reinforcement device (KT plate) with bulk structural allograft and metal mesh with impaction bone grafting (IBG).

METHODS

Ninety-one hips of 81 patients underwent revision THA for American Academy of Orthopedic Surgeons (AAOS) classification type III defects from 2008 to 2018. Of these, seven hips of five patients and 15 hips of 13 patients were excluded due to insufficient follow-up information (< 24 months) and large bone defects with a vertical defect height ≥ 60 mm, respectively. The current study compared the survival and radiographic parameters of 45 hips of 41 patients using a KT plate (KT group) and 24 hips of 24 patients using a metal mesh with IBG (mesh group).

RESULTS

Eleven hips (24.4%) in the KT group and 1 hip (4.2%) in the mesh group exhibited radiological failure. Moreover, 8 hips in the KT group (17.0%) required a re-revision THA, while none of the patients in the mesh group required a re-revision. The survival rate with radiographic failure as the endpoint in the mesh group was significantly higher than that in the KT group (100% vs 86.7% at 1-year and 95.8% vs 80.0% at 5-years, respectively; p = 0.032). On multivariable analysis evaluating factors associated with radiographic failure, there were no significant associations with any radiographic measurement. Of the 11 hips with radiographic failure, 1 (11.1%), 3 (12.5%), and 7 (58.3%) hips were of Kawanabe classification stages 2, 3, and 4, respectively.

CONCLUSIONS

The findings of this study suggest that revision THA using KT plates with bulk structure allografts could provide poorer clinical outcomes than revision THA using a metal mesh with IBG. Although revision THA using KT plates with bulk structural allografts could set the true hip center, there is no association between a high hip center and clinical outcomes. The relationship between the position of the KT plate and the host bone might be considered more carefully.

Revision total hip arthroplasty using a Kerboull-type acetabular reinforcement device and allogeneic structural bone graft

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.

Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects

BACKGROUND

Revision surgery for complex acetabular defects is still technically challenging. In this study, we discussed and compared the clinical and radiological outcomes of revision surgery between two methods using double-trabecular metal (TM) cups alone or combined with impacting bone grafting (IBG).

METHODS

The records of 18 patients (18 hips) who underwent revision surgery using double-trabecular metal (double-TM) cups between 2008 and 2016 were retrospectively reviewed. All the patients were diagnosed with Paprosky III acetabular defects. The acetabular defects were reconstructed by double-TM cups alone or in combination with IBG. We used the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA), and Short Form 36 (SF-36) to evaluate the clinical outcomes. Pelvis plain X-ray was used to assess hip center of rotation (COR), abduction angle and anteversion angle of acetabular cup, and incorporation of the bone graft to host bone.

RESULTS

The median follow-up time was 61.0 (IQR 56.0 to 65.8) months. No patients underwent re-revision for loosening or any other reasons. Complications included 3 patients (16.7%) with early dislocation and 3 patients (16.7%) with delayed wound healing. The average mHHS and UCLA preoperatively were 44.1 ± 4.0 (range 35 to 50) and 2.6 ± 0.7 (range 2 to 4), respectively and at the last follow-up were 73.7 ± 4.2 (range 68 to 85) and 7.3 ± 0.5 (range 7 to 8), respectively. The mean SF-36 scores at the last follow-up were improved significantly than preoperative scores, especially in bodily pain category (P < 0.05). The average limb-length discrepancy (LLD) decreased significantly from 24.2 ± 2.6 (range 20 to 32) mm preoperatively to 5.8 ± 1.8 (range 3 to 9) mm at the last follow-up, respectively. However, there was no significant difference between two methods at the last follow-up in terms of mHHS, UCLA, SF-36, LLD, and hip COR (P > 0.05). Radiographic evaluation demonstrated bone graft incorporation in all hips in the follow-up.

CONCLUSIONS

Defect reconstruction using double-TM cups alone or combined with IBG are practical and reliable treatment options for Paprosky III acetabular defects without pelvic discontinuity. Nevertheless, high postoperative complication rate, especially in terms of dislocation, remains a challenge.

Analgesic impact of buprenorphine transdermal patch in total hip arthroplasty: A randomized controlled trial protocol

BACKGROUND

The efficacy and safety of buprenorphine transdermal patch (BTP) has been well established in chronic pain, but data regarding acute postoperative pain relief is still very limited. Therefore, we design a prospective, randomized, controlled study to evaluate the effectiveness and safety of the BTP for postoperative analgesia in total hip arthroplasty.

METHODS

This study is designed as a single-center, prospective, double-blind, randomized controlled trial. Group A receives a 10 mg patch of buprenorphine at the conclusion of surgery which is continued for 14 days. Group B receives a conventional analgesic regimen, that is, IV paracetamol 1 mg every 8 hours alternating with parenteral tramadol 50 mg every 8 hours for the first 2 postoperative days followed by oral administration of the same drug still the end of 2 weeks. A total of 160 patients are needed with an allowance for 10% drop-out. The primary outcome of this noninferiority study is opioid consumption within the first 24 hours following surgery. The secondary outcomes included numerical rating scale scores at rest, postoperative complications, length of hospital stay, and patient satisfaction.

RESULTS

This trial is expected to be the largest randomized trial assessing the efficacy of BTP after primary total hip arthroplasty and powered to detect a potential difference in the primary outcome.

TRIAL REGISTRATION NUMBER

This study protocol was registered in Research Registry (researchregistry5524).