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Gehrke T, Citak M, Akkaya M. Individualized megaimplants in acetabular revision arthroplasty: what have we learned in the last 15 years? EFORT Open Rev 2024; 9:357-362. [PMID: 38726981 PMCID: PMC11099577 DOI: 10.1530/eor-24-0064] [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: 05/12/2024] Open
Abstract
Acetabular revision arthroplasty, a demanding field of reconstructive hip surgery, calls for innovative strategies to deal with challenging bone defects and implant failure seen in revision cases. Conventional implant solutions might fall short of adequately addressing severe bone loss and ensuring stable fixation, highlighting the necessity of customized strategies. Personalized megaimplants, distinguished by their tailor-made design and large-scale construction, present a viable option to overcome these challenges. The present article provides an elaborate analysis of custom-made megaimplants in acetabular revision arthroplasty, shedding light on the underlying principles, design complexities, manufacturing methods, applications in the clinical setting, and outcome assessment. The aim of this review is to present a comprehensive insight into personalized megaimplants and their contribution to the advancement of orthopedic surgery.
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Affiliation(s)
- Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany
| | - Mustafa Akkaya
- Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany
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Jones SA, Parker J, Horner M. Can a reconstruction algorithm in major acetabular bone loss be successful in revision hip arthroplasty? Bone Joint J 2024; 106-B:47-53. [PMID: 38688489 DOI: 10.1302/0301-620x.106b5.bjj-2023-0809.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aims of this study were to determine the success of a reconstruction algorithm used in major acetabular bone loss, and to further define the indications for custom-made implants in major acetabular bone loss. Methods We reviewed a consecutive series of Paprosky type III acetabular defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical acetabular component. IIIB defects were planned to receive either a hemispherical acetabular component plus augments, a cup-cage reconstruction, or a custom-made implant. We used national digital health records and registry reports to identify any reoperation or re-revision procedure and Oxford Hip Score (OHS) for patient-reported outcomes. Implant survival was determined via Kaplan-Meier analysis. Results A total of 105 procedures were carried out in 100 patients (five bilateral) with a mean age of 73 years (42 to 94). In the IIIA defects treated, 72.0% (36 of 50) required a porous metal augment; the remaining 14 patients were treated with a hemispherical acetabular component alone. In the IIIB defects, 63.6% (35 of 55) underwent reconstruction as planned with 20 patients who actually required a hemispherical acetabular component alone. At mean follow-up of 7.6 years, survival was 94.3% (95% confidence interval 97.4 to 88.1) for all-cause revision and the overall dislocation rate was 3.8% (4 of 105). There was no difference observed in survival between type IIIA and type IIIB defects and whether a hemispherical implant alone was used for the reconstruction or not. The mean gain in OHS was 16 points. Custom-made implants were only used in six cases, in patients with either a mega-defect in which the anteroposterior diameter > 80 mm, complex pelvic discontinuity, and massive bone loss in a small pelvis. Conclusion Our findings suggest that a reconstruction algorithm can provide a successful approach to reconstruction in major acetabular bone loss. The use of custom implants has been defined in this series and accounts for < 5% of cases.
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Affiliation(s)
- Stephen A Jones
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Jack Parker
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Matthew Horner
- Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
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Ansari S, Gupta K, Gupta T, Raja BS, J P, Kalia RB. Total Hip Arthroplasty in Protrusio Acetabuli: A Systematic Review. Hip Pelvis 2024; 36:12-25. [PMID: 38420735 DOI: 10.5371/hp.2024.36.1.12] [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: 07/17/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 03/02/2024] Open
Abstract
Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.
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Affiliation(s)
- Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kshitij Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India
| | - Pranav J
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Abu-Awwad A, Tudoran C, Patrascu JM, Faur C, Tudoran M, Mekeres GM, Abu-Awwad SA, Csep AN. Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1640. [PMID: 36837270 PMCID: PMC9966432 DOI: 10.3390/ma16041640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015-1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020-31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients' management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic.
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Affiliation(s)
- Ahmed Abu-Awwad
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Department VII, Internal Medicine II, Discipline of Cardiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Academy of Romanian Scientists, Ilfov Str. Nr. 3, 030167 Bucuresti, Romania
| | - Jenel Marian Patrascu
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Cosmin Faur
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Mariana Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
| | - Gabriel Mihai Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Andrei Nicolae Csep
- Faculty of Medicine and Pharmacy, University of Oradea, Universitatii Street No.1, 410087 Oradea, Romania
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D’Apolito R, Zagra L. Correction: D'Apolito, R.; Zagra, L. Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes. Materials 2022, 15, 3728. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5683. [PMID: 36013936 PMCID: PMC9412461 DOI: 10.3390/ma15165683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
The authors wish to make the following correction to this paper [...].
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In Silico Contact Pressure of Metal-on-Metal Total Hip Implant with Different Materials Subjected to Gait Loading. METALS 2022. [DOI: 10.3390/met12081241] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of material for implant bearing has a vital role in minimizing failures that endanger implant recipients. Evaluation of contact pressure of bearing material can be the basis for material selection and have correlations with wear that contribute to the need of revision operations. The current paper aims to investigate three different metallic materials, namely cobalt chromium molybdenum (CoCrMo), stainless steel 316L (SS 316L), and titanium alloy (Ti6Al4V) for application in metal-on-metal bearing of total hip implant in terms of contact pressure. In silico model based on finite element simulation has been considered to predict contact pressure of metal-on-metal bearings under normal walking conditions. It is found that the use of Ti6Al-4V-on-Ti6Al4V is superior in its ability to reduce contact pressure by more than 35% compared to the other studied metal-on-metal couple bearings.
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