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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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Park JS, Kweon SH, Kang SJ, Jo YH. Long-term Follow-up Results of Femoral Revision Hip Arthroplasty Using Impaction Bone Grafting and Standard Cemented Polished Stem. Clin Orthop Surg 2023; 15:734-739. [PMID: 37811512 PMCID: PMC10551692 DOI: 10.4055/cios23052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency. Methods We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39-75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts. Results The modified HHS improved from an average of 55.04 (range, 25-79.5) preoperatively to 90.1 (range, 81-93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9-17.8 years). The radiographic analysis revealed stable stems. Femoral stems showed an average subsidence of 3.2 mm (range, 2-8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting. Conclusions Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.
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Affiliation(s)
- Jin Sung Park
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Seok Hyun Kweon
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Sung Ju Kang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
| | - Yang Hun Jo
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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Femoral Head Autograft to Manage Acetabular Bone Loss Defects in THA for Crowe III Hips by DAA: Retrospective Study and Surgical Technique. J Clin Med 2023; 12:jcm12030751. [PMID: 36769400 PMCID: PMC9918157 DOI: 10.3390/jcm12030751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction: The pathologic anatomy of Crowe III is characterized by the erosion of the superior rim of acetabulum, with a typical bone defect in its supero-lateral portion. The performance of a total hip arthroplasty requires the management of the acetabular bone defect, and femoral head autograft can be a valid option to optimize implant coverage. Material and Methods: In all, eight Crowe III patients (nine hips), seven of which having unilateral hip affected, and one with bilateral involvement by secondary osteoarthritis in DDH; maximum limb length discrepancy (LLD) of 3.5 cm in unilateral patients. All were operated on by direct anterior approach. Patients were evaluated in terms of clinical, surgical, and radiological (center-edge, horizontal coverage, cup inclination) parameters. Results: Cup placement was implanted with a mean of 39.5 ± 7.5°. Stem alignment showed average 1.5 ± 2.3° in valgus. LLD showed an overall average preoperative of -29.5 ± 10.5 mm at the affected side, with a significant improvement to -2.5 ± 6.4 mm (p = 0.023). The mean initial coverage evaluated like a percentage of the horizontal bone host was 52.1 ± 7.1%, while the mean final coverage at the last post-operative X-ray from femoral autograft bone was 97.0 ± 4.5% with an average improvement of 44.5%. Average CE improved from -9.5 ± 5.2° (CE I) to the immediate post-operative (CE II) of 40.6 ± 8.2°. At the final follow up, CE III showed a mean of 38.6 ± 6.2°, with an average decrease of 2.0°. Discussion: Acetabular bone defect in Crowe III DDH patients undergoing THA by DAA, can be efficiently managed by massive autograft femoral head, which allowed an adequate and long-lasting coverage of the implant, with cup positioning at the native acetabulum.
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Comba LC, Bellato E, Colombero D, Mattei L, Marmotti A, Castoldi F. Revision of Total Hip Arthroplasty with Acetabular Bone Defects: Are Biological Grafts Really Better than Synthetic Bone Graft Substitutes? THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:568-575. [PMID: 36032645 PMCID: PMC9382253 DOI: 10.22038/abjs.2021.53380.2666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/13/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acetabular aseptic loosening due to bone defect in total hip arthroplasty revisions is a great challenge and several solutions have been proposed, but a broadly accepted consensus in the literature has not been reached yet. The aim of this study is to compare the clinical and radiographic results of acetabular bone defects treatment with biological-only graft or with a mixture of bone graft substitute and biological graft. METHODS 33 patients had revision hip arthroplasty using impaction grafting with biological-only graft (21 patients, Group A) or a 1/3 mixture of allograft and tricalcium phosphate bone graft substitute (12 patients, Group B). Patients were reassessed at a minimum of one year after surgery with new x-rays and the Harris Hip Score (HHS). RESULTS Survivorship of bone graft was 86% in Group A and 100% in Group B at a mean follow-up of 35 months. No statistical difference between the two groups was found in terms of implants survivorship (P=0.28), clinical (P=0.08) or radiographic (P=0.27) outcomes. CONCLUSION In our experience the use of tricalcium phosphate bone graft substitutes in combination with allo and autograft provides good outcomes, low risk of failure and great clinical and radiographic results. Further investigations on larger samples are needed to impact clinical practice.
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Affiliation(s)
| | - Enrico Bellato
- San Luigi Gonzaga Hospital, University of Turin Medical School, Orbassano, Turin, Italy
| | - Danilo Colombero
- San Luigi Gonzaga Hospital, University of Turin Medical School, Orbassano, Turin, Italy
| | | | - Antongiulio Marmotti
- San Luigi Gonzaga Hospital, University of Turin Medical School, Orbassano, Turin, Italy
| | - Filippo Castoldi
- San Luigi Gonzaga Hospital, University of Turin Medical School, Orbassano, Turin, Italy
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Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2022; 46:789-795. [DOI: 10.1007/s00264-021-05280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Pisanu F, Andreozzi M, Fiori E, Altamore F, Bartoli M, Caggiari G, Ortu S, Rios M, Manunta AF, Doria C. Surgical management of hip prosthetic failure in metallosis: A case series and literature review. J Orthop 2021; 28:10-20. [PMID: 34707335 DOI: 10.1016/j.jor.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/21/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022] Open
Abstract
Local and remote complications can be observed in hip prosthesis failures associated with metallosis. Structural changes in the periprosthetic bone and soft tissues may not always be precisely assessed preoperatively due to metal artifacts. The unpredictability of the damage extension, potentially leading to complex and insidious surgeries, requires the availability of alternative surgical plan(s) for the reconstruction of the joint. The aim of the study is to present and analyze, with the literature data support, practical tips for the revision of the prosthetic components, the management of ARMD and of intraoperative complications in the unusual scenario of metallosis.
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Affiliation(s)
- Francesco Pisanu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Matteo Andreozzi
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Enrico Fiori
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Fabiana Altamore
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Marco Bartoli
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Gianfilippo Caggiari
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Sebastiano Ortu
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Mario Rios
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Andrea Fabio Manunta
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
| | - Carlo Doria
- Orthopedics and Traumatology Department, Viale San Pietro 24, 07100, Sassari, Italy
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Romagnoli S, Marullo M, Corbella M, Zero E, Parente A, Bargagliotti M. Conical Primary Cementless Stem in Revision Hip Arthroplasty: 94 Consecutive Implantations at a Mean Follow-Up of 12.7 years. J Arthroplasty 2021; 36:1080-1086. [PMID: 33187858 DOI: 10.1016/j.arth.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision of a failed total hip arthroplasty (THA) poses technical challenges. The use of primary stems for revision can be advantageous for maintaining bone stock and reducing complications: small case series have reported promising results in the short-term to mid-term follow-up. The aim of this study was to evaluate the long-term clinical and functional results and survivorship of a consecutive series of THA femoral component revisions using a conical primary cementless stem (PCS). METHODS Ninety-four stem revisions with a preoperative Paprosky I or II defect were analyzed at an average follow-up of 12.7 ± 5.4 years. Aseptic loosening was the reason for revision in 92.5% of cases. Twenty patients were lost to follow-up. Two subgroups were created: Group 1 (n = 59) underwent isolated stem revision; Group 2 (n = 15) underwent complete THA revision. All were evaluated preoperatively and postoperatively based on the Harris Hip Score (HHS), the Western Ontario and McMaster Universities Index (WOMAC) score, and the visual analog scale for pain (VAS). Residual trochanteric pain and length discrepancies were recorded. Radiographic evaluation included signs of osteolysis, subsidence, loosening, and heterotopic ossification. RESULTS PCS survivorship was 100% at 5 years and 95.9% at 10 years. Overall, significant postoperative improvements (P < .01) were observed on the HHS (44.3 vs 86.9), WOMAC (42.8 vs 82.8), and VAS (7.0 vs 3.0). Postoperative scores on all scales were higher for Group 1 (P < .01). Three patients (4.1%) underwent further stem revision. Demarcation lines (1 mm) were found in 12 (16.2%) patients and significant heterotopic ossifications in 22 (29.7%). CONCLUSION The use of PCS for stem revision in failed THA with a limited femoral bone defect is a reliable option for both isolated stem revision and concomitant cup revision in well-selected patients.
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Affiliation(s)
- Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Michele Corbella
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Enrico Zero
- Department of Informatics, Bioengineering, Robotics and System Engineering of the University of Genoa, Genoa, Italy
| | - Andrea Parente
- Orthopedics and Traumatology Department, University of Milan, Milan, Italy
| | - Marco Bargagliotti
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. Arch Orthop Trauma Surg 2021; 141:509-516. [PMID: 33354743 PMCID: PMC7900083 DOI: 10.1007/s00402-020-03722-x] [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: 09/18/2020] [Accepted: 12/06/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Restoration cages and bone allografts have been proposed to manage severe acetabular bone defects. We aimed to investigate the migration behaviour of a restoration cup and impacted allograft bone in severe acetabular defects with Einzel-Bild-Röntgen-Analyse (EBRA). METHODS Applying a retrospective study design, 64 cases treated between 2009 and 2016 were reviewed. We determined the preoperative Charlson Comorbidity Index (CCI), pre- to postoperative WOMAC score, blood loss and functional outcome. From preoperative x rays, the acetabular deficiencies were classified according to Paprosky. Cup migration analyses were performed with EBRA. RESULTS Mean age at surgery was 73 (range: 38-93) years. According to the classification by Paprosky et al., 50% (n = 32) of our patients showed a type III B and 28.1% (n = 18) a type III A defect. Radiological follow-up for migration analysis was 35 (range: 4-95) months. Migration analysis showed a mean cup migration of 0.7 mm (range: 5.7-9.6) medial and 1.8 mm (range: 1.7-12.6) cranial. CONCLUSION In conclusion, acetabular restoration cages in combination with bone impaction grafting showed a low revision rate at a mean follow-up of 35 months. Mean cup migration revealed low rates after 2 years and suggested a stable postoperative implant position.
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Tikhilov RM, Shubnyakov II, Denisov AO. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases). TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2019. [DOI: 10.21823/2311-2905-2019-25-1-122-141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R. M. Tikhilov
- Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University
| | - I. I. Shubnyakov
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - A. O. Denisov
- Vreden Russian Research Institute of Traumatology and Orthopedics
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