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Liu Q, Zhang RW, Ma RX, Zhu WB, Zhang XZ, Zhu C. Outcomes of a Double-Cup Construct to Treat Paprosky 3A and 3B Acetabular Defects at a Mean of 39 Months. J Arthroplasty 2024:S0883-5403(24)00542-4. [PMID: 38823520 DOI: 10.1016/j.arth.2024.05.070] [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: 10/22/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Modular reconstruction systems based on porous tantalum (PT) prosthetic components have been increasingly used for the treatment of complex acetabular bone defects in revision total hip arthroplasty. We report a novel technique that applies a revision cup as a "super-augment" to form a "double-cup" construct for Paprosky type III defects. METHODS A retrospective review was conducted on revision total hip arthroplasty cases, comparing those treated with double-cup constructs (DC group, n = 48) to those treated with PT shells and augments (PT group, n = 48). All procedures were performed at the same institute between 2017 and 2022. Clinical outcome evaluation utilized the Harris Hip Score, Oxford Hip Score, and the 36-Item Short Form Survey. Preoperative and postoperative radiographic assessments measured hip center of rotation (COR) position and leg length discrepancy. Additionally, postoperative complications and implant survivorship were monitored during the follow-up period. RESULTS The clinical outcomes improved substantially in both groups, which showed no significant difference in the Harris Hip Score (P = .786), the Oxford Hip Score (P = .570), and the 36-Item Short Form Survey (P = .691). Compared to the PT group, the reconstruction COR was significantly closer to the anatomic COR (vertical distance: 2.630 versus 7.355 mm, P = .0034; horizontal distance: 1.881 versus -6.413 mm, P < .0001) in Paprosky 3B type defects. Additionally, postoperative leg length discrepancy was less in the DC group (-8.252 versus -1.821 mm, P = .0008). Dislocation was the main complication in the DC group, and only 1 patient received re-revision due to repeated dislocation. The cumulative survival rate of the DC group (100%; 95% confidence interval 100) was better than the PT group (83.4%; 95% confidence interval 70.5 to 98.6) when re-revisions for aseptic loosening were the endpoint (P = .046). CONCLUSIONS The DC is a reliable revision technique for the reconstruction of Paprosky type III bone defects. Although dislocation remains challenging, the biomechanically superior restoration achieved by this technique lowers the risk of aseptic loosening.
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Affiliation(s)
- Quan Liu
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Rong-Wei Zhang
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Rui-Xiang Ma
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Wan-Bo Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xian-Zuo Zhang
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Chen Zhu
- Division of Life Sciences and Medicine, Department of Orthopaedics, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
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Mirghaderi P, Eshraghi N, Sheikhbahaei E, Razzaghof M, Roustai-Geraylow K, Pouramini A, Eraghi MM, Kafi F, Javad Mortazavi SM. Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 25:101293. [PMID: 38298809 PMCID: PMC10827600 DOI: 10.1016/j.artd.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 02/02/2024] Open
Abstract
Background Studies suggest tantalum (Ta) implants may have inherent antibacterial properties. However, there is no consensus regarding the effectiveness of Ta in preventing periprosthetic joint infection (PJI) after revision total hip arthroplasty (rTHA). Methods We searched 5 main databases for articles reporting the rate of PJI following rTHA using Ta implants from inception to February 2022. The PJI rates of the Ta group were meta-analyzed, compared with the control group, and represented as relative risks (RRs) in forest plots. Results We identified 67 eligible studies (28,414 joints) for assessing the prevalence of PJI following rTHA using Ta implants. Among these studies, only 9 compared the Ta implant group with a control group. The overall PJI rate following rTHA using Ta implants was 2.9% (95% confidence interval [CI]: 2.2%-3.8%), while it was 5.7% (95% CI = 4.1%-7.8%) if only septic revisions were considered. Comparing the Ta and control groups showed a significantly lower PJI rate following all-cause rTHA with an RR = 0.80 (95% CI = 0.65-0.98, P < .05). There was a trend toward lower reinfection rates in the Ta group after rTHA in septic cases, although the difference was not statistically significant (RR = 0.75, 95% CI = 0.44-1.29, P = .30). Conclusions Ta implants are associated with a lower PJI rate following all-cause rTHA but not after septic causes. Despite positive results, the clinical significance of Ta still remains unclear since the PJI rate was only reduced by 20%. Level of Evidence IV.
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Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Roustai-Geraylow
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kafi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ebied A, Ebied AA, Badr IT, Affara M, Marie S. Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group. BMC Musculoskelet Disord 2023; 24:97. [PMID: 36740673 PMCID: PMC9900940 DOI: 10.1186/s12891-023-06204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-operative dislocation and reconstruction of acetabular defects are two challenging topics in revision Total Hip Arthroplasty (rTHA). Cemented Dual Mobility (DM) cups on top of Kerboull Cross and bone graft have been successfully employed to overcome these challenges. The cementless augmented DM cups were recently introduced. In this study medium term results of the augmented cementless DM Coptos cups are reported and compared to the established technique of cemented DM cups and Kerboull plate. MATERIAL AND METHODS This is a retrospective analysis of data collected on patients who received rTHA using DM cups in the period between June 2015 and September 2020. Two groups of patients were identified. The first group received cementless augmented DM-cups (NOVAE® Coptos TH-SERF) (Coptos TH cup group). The second comparable group who had Kerboull ring (KE ring group) and cemented DM cups (NOVAE® STICK). Demographic data, surgical technique, functional and radiological outcome as well as complications during the follow-up visits are reported. RESULTS Forty-two patients with a mean age at the time of revision 48.8 ± 13.6 years. 29 patients received Coptos TH DM-cup, while 13 patients had Bone Graft (BG), KE ring and cemented DM cups for acetabular reconstruction. Acetabular defects were Paprosky types IIB and IIC in 31 patients and IIIA and B in 11 patients. The follow-up was 52.8 ± 21 months (mean ± STD); and the mean Harris Hip Score (HHS) at last visit was 91 ± 5. Good stability of all cups was reported. Full integration of the impaction graft was observed in 94% of the Coptos and 92% of the KE groups. One of the Coptos cups was readjusted and one case of single dislocation was recorded in the KE group. None of the DM cups in both groups was revised or awaiting revision. CONCLUSION Coptos TH cups achieve similar results to the cemented DM on KE ring at the medium term but long term outcome remains to be seen.
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Affiliation(s)
- Ayman Ebied
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Ahmed Ali Ebied
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Ismail Tawfeek Badr
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Mostafa Affara
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Sameh Marie
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
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Zhang X, Tang X, Li Z, Zhang X, Li F, Tao C, Liu T. Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients. J Orthop Surg (Hong Kong) 2022; 30:10225536221095202. [PMID: 35491561 DOI: 10.1177/10225536221095202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Femoral bone deficiency is a challenging problem in revision proximal femoral replacement. The purpose of this study is to evaluate the clinical and radiological outcomes of revision proximal femoral replacement as a salvage treatment for severe bone loss after oncologic proximal replacement surgery in patient with benign giant cell tumor of bone. METHODS 16 patients (6 men and 10 women) were included in this retrospective study, with a mean age of 46.6 year at the time of revision surgery. All patients underwent revision proximal femoral replacement with the use of modular prosthesis and cortical strut allografts. The modified Harris Hip Score, Short Form 36, and musculoskeletal Tumor Society Score were used for patient evaluation. Regular follow-up was performed to evaluate the recurrence and metastases rate, limb function, and long-term complications of patients. RESULTS The average follow-up was 46.3 months (range, 26-75 months), during which there was no local recurrence and metastases of patient. At the latest follow-up, the mean modified Harris Hip Score was 70.6 points, which was significantly improved compared with that of preoperative (p < 0.05). The final follow-up results of Short Form 36, Musculoskeletal Tumor Society Score, and limb-length discrepancy were also significantly improved compared to that of preoperative (p < 0.05). At the latest follow-up, the implanted femoral stems were all stable and all cortical strut allografts were also incorporated to their own bone. CONCLUSION Using modular prosthesis and cortical strut allografts in revision, proximal femur replacement is an acceptable procedure for relatively young patient with severe proximal femoral bone loss after oncologic surgery with benign giant cell tumor of bone. More attentions should be paid to reduce the risk of complications in these complex reconstructions.
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Affiliation(s)
- Xianghong Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, China
| | - Xianzhe Tang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Orthopedics, Chenzhou No. 1 People's Hospital, Chenzhou, China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiangsheng Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fuming Li
- Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, China
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
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Perticarini L, Rossi SMP, Medetti M, Benazzo F. Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects. J Orthop Traumatol 2021; 22:9. [PMID: 33675431 PMCID: PMC7937008 DOI: 10.1186/s10195-021-00571-1] [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: 10/29/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery. METHODS Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29-90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect. RESULTS Average follow-up was 91 (range 24-146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25-70; SD 9) preoperatively to 84.4 (range 46-99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan-Meier survivorship was assessed to be 88.54% (95% CI 80.18-93.52%) at 71 months, with failure of the cup for any reason as the endpoint. CONCLUSION Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects. LEVEL OF EVIDENCE Level IV prospective case series.
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Affiliation(s)
- Loris Perticarini
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
| | - Marta Medetti
- Clinica Ortopedica e Traumatologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Sezione Di Chirurgia Protesica Ad Indirizzo Robotico - Unità Di Traumatologia Dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.,Università Degli Studi Di Pavia, Pavia, Italy
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Schiavi P, Pogliacomi F, Garzia A, Valenti P, Ceccarelii F, Calderazzi F. Survival and outcome of total elbow arthroplasty for distal humeral fracture at long term follow-up. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020031. [PMID: 33559624 PMCID: PMC7944693 DOI: 10.23750/abm.v91i14-s.11112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022]
Abstract
Background Total elbow arthroplasty is an accepted procedure for the treatment of acute comminuted distal humeral fractures in elderly. Few long-term outcomes are available. The purpose of this study was to examine long-term clinical and radiological outcomes of prosthesis performed (January 2002-June 2015) for complex intra- fractures of the distal humerus (AO/C) in patients older than 65 years with low functional demands. Materials and Methods Further inclusion criteria were: the availability of a clinical and radiological follow-up of minimum 5 years and pattern of closed fracture. Demographic data and characteristics of patients were collected. All patients were clinically and radiographically assessed after 2 and 5 years from surgery. Results Twelve patients were included with complete available data. The mean follow-up was 7.6 years. Five patients reported a worsening of the elbow functionality through the follow-ups. Five subjects had complications. There were no cases of revision surgery. The quality of fixation showed a progressive worsening with increase of radiolucency both on humeral and ulnar side. The recorded MEPS showed no correlation with the grade of periprosthetic osteolysis. Polyethylene bushing wear was scored of grade 2 in one subject who had showed type 4 Morrey radiolucency. Discussion and Conclusions Total elbow arthroplasty is an effective and reliable procedure for comminuted fractures of the distal humerus in elderly, although the incidence of complications can not be considered as negligible. For the majority of these patients, a well-performed implant will give them a well-functioning elbow for their remaining life.
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Affiliation(s)
- Paolo Schiavi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
| | - Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
| | - Alice Garzia
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
| | - Piergiulio Valenti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
| | - Francesco Ceccarelii
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy.
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