Abstract
Introduction
Acetabular revision surgery is becoming more prevalent with an estimated increase of 137% by 2030. It is challenging surgery especially in the presence of deficient bone loss. Several techniques of acetabular reconstruction are used world-wide. The greater the bone loss (Paprosky Type IIIA and IIIB, and AAOS Classification of Acetabular Bone Loss Type 3 and 4) the more complex are the reconstruction methods. There is however, insufficient literature comparing the contemporary techniques of revision acetabular reconstruction and their outcomes.
Objectives
The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal (TM) systems, uncemented revision jumbo cups, reinforced devices such as cages and rings, oblong cups and custom-made triflange cups). We specifically looked at outcomes when reconstruction was undertaken in the presence of bone loss.
Methods
Full-text papers and those with an abstract in English published from January 2001 to October 2015, identified through international databases, Medline (PubMED), EMBASE, CINHAL, Web of Science, Cochrane and Google scholar databases, were reviewed. Studies reporting failure and complications following the use of tantalum metal systems, uncemented revision jumbo cups, reinforced devices as cages and rings, oblong cups and custom-made triflange cups, were included. Functional and radiological outcomes were also evaluated.
Results
A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included.
1021 hips (291 of them classified Paprosky Type 3A, 98 3B and 14 AAOS type 3 and 2 type 4) with a mean follow-up 48.9 months, used TM cups with a mean overall re-revisions rate of 7.3%. 831 hips (156 of them classified Paprosky Type 3A, 178 3B and 228 AAOS type 3 and 43 type 4) with a mean follow-up 87.5 months, were reconstructed using cages and rings devices; these had a mean re-operation rate of 11.0%. 203 hips (44 of them classified Paprosky Type 3A and 8 3B) with a mean follow-up 90.9 months, were reconstructed using oblong cups and were associated with a mean of re-operate rate of 5.9%. In 518 hips (86 of them classified Paprosky Type 3A, 29 3B and 114 AAOS type 3 and 2 type 4) with a mean follow-up 117.4 months, jumbo cups were implanted and revision rate was 12.1%. Custom-made triflange cups were used in 238 hips (3 of them classified Paprosky Type 3A, 64 3B and 42 AAOS type 3 and 139 type 4) with a mean follow-up 57.9 months, and they were re-roperated in 16.8% of cases.
Overall patients had improved post-operative hip scores for each different procedure.
We have observed that oblong cups components had a lower failure rate compared with other different materials considered in this review.
Custom-made triflange cups had one of higher failure rate, however they had been used in the most complex cases. It is possible that other designs had more favourable outcomes having been used in less demanding patients.
Conclusions
This review confirms successful acetabular reconstructions using several techniques and highlights key features and outcomes of different techniques.
In particular oblong and TM cups have proven long-term survivorship and our results strongly suggest these devices as preferable choice especially in moderate to high-grade acetabular defects.
For hip revisions following the development of pelvic discontinuity custom-made triflange cups have a main role, however the results are not always favourable.
