10-Year Survival of Acetabular Reinforcement Rings/Cages for Complex Hip Arthroplasty

Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation

Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.

Long-term functional results of revision hip replacement using Burch-Schneider cages

Introduction

One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results.

Methods

Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B.

Results

Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3.

Conclusions

The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.

Custom Triflange Acetabular Components For Catastrophic Bone Loss: Minimum 5-Year Results

INTRODUCTION

Custom acetabular components are an increasingly utilized reconstructive option in total hip arthroplasty for catastrophic bone loss and acetabular failure. The purpose of this study was to determine the survivorship of such components for reconstruction due to catastrophic bone loss at a minimum 5-year follow-up.

METHODS

From August 2003 to July 2016, 64 patients (66 hips) underwent acetabular reconstruction with custom triflange components. All hips were classified as Paprosky 3B or 3C. Harris hip scores were analyzed. Overall survivorship was determined by survival analysis.

RESULTS

Seventeen patients (18 hips) died prior to returning for 5-year follow-up. One presumed living patient was lost to contact, yielding a cohort of 46 patients (47 hips) who had minimum 5-year follow-up. The mean age was 65 years (range, 46 to 85), mean body mass index was 29.4 (range, 18 to 45), and 72% were women. Mean follow-up was 8 years (range, 5 to 16). There were 3 revisions of the triflange device (6.4%) due to infection. Survivorship to end point of triflange removal for any reason was 94.1% (95% confidence interval: ±3.4%) at a mean of 16 years. In the overall series (n = 66), there were 9 (13.6%) additional reoperations as follows: 5 incision and debridements, one open reduction internal fixation, two stem revisions for periprosthetic femoral fracture, and one head revision. Harris hip scores improved significantly from a mean of 41 points preoperatively to 64 points postoperatively.

CONCLUSIONS

Custom acetabular triflange components represent a highly effective tool in a surgeon's armamentarium. These devices are extremely helpful in managing catastrophic bone loss and have a good mean 16-year survival.

Clinical and Radiological Outcome of Acetabular Reconstruction Rings in Complex Primary and Revision Total Hip Arthroplasty

BACKGROUND

Acetabular reconstruction in complex primary and revision total hip arthroplasty (THA) with bone loss poses a great challenge. We aim to evaluate the medium-term clinical and radiological outcome of reconstruction rings used in these difficult situations.

METHODS

We retrospectively reviewed a consecutive series of acetabular reconstructions with Muller ring or Bursh-Schneider cage from January 2009 to December 2016. The reconstruction rings were used in 66 hips (65 patients). There were 41 complex primary THA and 25 revision THA. The mean follow-up period was 76 months (range, 37-167 months). Clinical evaluation includes the assessment of Harris hip score, visual analogue scale (VAS) score, limb length discrepancy, and activities of daily living. The radiographs were analyzed for any signs of loosening, osteolysis, acetabular migration, and heterotopic ossification.

RESULTS

The overall survival rate was 95% for revision in aseptic loosening and 87% for any reason at an average follow-up of 6.3 years. Twelve patients died and 9 patients were lost to follow-up leaving 45 patients for final functional analysis. Among the 45 patients, excellent to good results were seen in 33 patients, fair results were seen in 5 patients, poor results were seen in seven patients. Two patients had aseptic loosening and another two patients developed deep chronic infection awaiting two-stage revision.

CONCLUSION

Reconstruction rings still place a role in the armamentarium for complex acetabular reconstruction. It helps to reliably restore the bone stock, have an acceptable survival rate and satisfactory functional outcome at medium to long-term follow-up.

Titanium cage reconstruction of acetabular defects in revision hip arthroplasty results in favourable outcomes: up to 17 years follow-up

INTRODUCTION

Titanium cages are valuable implant solutions in management of severe acetabular defects during total hip revisions. We aimed to report clinical and radiological results of our cases in which we used titanium cages for reconstruction of acetabular defects.

METHODS

Patients underwent titanium cage reconstruction and bone grafting for their acetabular defects with minimum 2 year-follow-up are included to the study. Analysis of patient records, modified Hospital for Special Surgery hip score and radiological examinations on plain X-rays were evaluated. Acetabular defects are classified according to Paprosky's classification.Kaplan Meier survival analysis is performed.

RESULTS

Fifty-six hips of 54 patients (2 bilateral) aged between 29-79 (mean 57 years ) are followed up for 7.06 years ±3.72 (2-17 years).Five patients required revision surgeries at a mean of 2.6±2.2 years. Kaplan Meier's analysis revealed a survival rate of 91,5 % and mean revision free duration was 15,66±0,56 years.HSS scores of the patients before revision surgery yielded a mean score of 27,9 ± 4,9 (14-38). HSS scores at final follow up showed a significant improvement at a mean score of 45,9 ± 7 (28-56) differences were statistically significant, p<0,001).

DISCUSSION

Titanium cages are successful for restoring bone stock in severe acetabular defects. It is critical to pay attention on meticulous bone grafting of the presented defects and obtain good hip mechanics during cage insertion. Mechanical reasons are the leading cause of failure in long term but restoration of the bone stock and improvement in defect severity were regularly observed even in failed cages.