Stemmed acetabular cup as a salvage implant for revision total hip arthroplasty with Paprosky type IIIA and IIIB acetabular bone loss.
Orthop Traumatol Surg Res 2020;
106:589-596. [PMID:
32265174 DOI:
10.1016/j.otsr.2020.01.012]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION
Certain cases of repeated acetabular loosening with severe bone loss are hardly amenable to reconstruction using a Kerboull-type plate with allograft. This limitation is more likely when the severe bone loss occurs in older adults with significant comorbidities that may require a faster procedure. In these indications, a stemmed acetabular cup may be an alternative, although the outcomes have not been well defined, especially for a version where the peg is coated with porous material and additional screws can be added. This led us to conduct a retrospective study to determine: (1) whether a stemmed cup anchored in the iliac isthmus is a viable alternative in these situations, (2) the complication rate and (3) the revision rate for any reason.
HYPOTHESIS
A stemmed cup anchored in the iliac isthmus is a viable alternative in cases of repeated revision with severe acetabular bone loss.
MATERIALS AND METHODS
We performed a retrospective single-center study. Sixteen Integra™ cups were implanted in 14 patients (mean age 72.8±10.4 years, minimum-maximum: 58-95) who had aseptic acetabular loosening combined with severe acetabular bone loss graded as Paprosky IIIA in 7 hips and IIIB in 9 hips. The patients had undergone a mean of 2.7±1.8 (minimum-maximum: 1-6) procedures (i.e. primary and/or revision arthroplasty) before this cup was implanted. The cup's survivorship at the time of review and the complication rate were determined.
RESULTS
At a mean follow-up of 48.8±23.4 months (minimum-maximum: 7-85), two patients had died and two were lost to follow-up. Six hips experienced one or more complications (37.5%): three infections (18.8%), two mechanical failures (12.5%) and one dislocation (6.7%). The cup had to be removed in three patients (18.8%). These complications required reoperation, thus the cumulative incidence of revision for any reason at 5 years was 31% (95% CI: 11-55%).
CONCLUSION
Despite the high complication and revision rates, we believe the stemmed acetabular cup is a viable alternative in salvage reconstruction procedures.
LEVEL OF EVIDENCE
IV, Retrospective case study.
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