Aims

The use of a porous metal shell supported by two augments with the ‘footing’ technique is one solution to manage Paprosky IIIB acetabular defects in revision total hip arthroplasty. The aim of this study was to assess the medium-term implant survival and radiological and clinical outcomes of this technique.

Trabecular metal (TM) augments are designed to support an uncemented socket in revision surgery when adequate rim fit is not possible. We have used TM augments in an alternative arrangement, to contain segmental defects to facilitate impaction bone grafting (IBG) and cementation of a cemented socket. However, there is a paucity of literature supporting the use of this technique. We present one of the largest studies to date, reporting early outcomes of patients from a tertiary centre. A single-centre retrospective analytical study of prospectively collected data was performed on patients who had undergone complex acetabular reconstruction using TM augments, IBG and a cemented cup. All patients operated between 2015 and 2019 were included. We identified 105 patients with a mean age of 74yrs. The mean follow-up was 2.3 years(1–5.5yrs). Our primary outcome measure was all-cause revision of the construct. The secondary outcome measures were, Oxford hip score (OHS), radiographic evidence of cup migration/loosening and post-op complications. Eighty-four out of 105 patients belonged to Paprosky grade IIb, IIc or IIIa. Kaplan-Meier survivorship for all-cause revision was 96.36% (CI, 90.58–100.00) at 2 years with 3 failures. Two were due to early infection which required two-stage re-revision. The third was due to post-operative acetabular fracture which was then re-revised with TM augment, bone graft and large uncemented cup. Pre-op and post-op matched OHS scores were available for 60 hips(57%) with a mean improvement of 13 points. Radiographic analysis showed graft incorporation in all cases with no evidence of cup loosening. The mean vertical cup migration was 0.5mm (Range −5 to 7mm). No other complications were recorded. This study shows that reconstruction of large acetabular defects during revision THA using a combination of TM augments to contain the acetabulum along with IBG to preserve the bone stock and a cemented socket is a reliable and safe technique with low revision rates and satisfactory clinical and radiographic results. Long term studies are needed to assess the possibility of preservation and regeneration of bone stock

Aims

There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA.

Aims

Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants.

Aims

Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed.

Aims

We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA).

Aims

Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants.

Aims

The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique.

Aims

We present our experience of using a metal-backed prosthesis and autologous bone graft to treat gross glenoid bone deficiency.

Reconstruction of massive acetabular bone defects in primary and revision THA is challenging for reconstructive joint surgeons. The use of porous metal augments is one of the options. The advantages of porous metal augments are easy to use, modularity and lack of resorption. We investigated the radiological results of porous metal augments used for massive acetabular bone defects in primary and revision THA. Forty-one hips in forty patients had porous metal augments between 2011 and 2016. Thirty of the procedures were revision arthroplasties and 11 were primary procedures (Crowe type III in 5 hips, Crowe type IV in 3, septic hip sequalae in 2 and RA in one). Four of the revisions were second-stage reimplantation after infection. The Paprosky classification for revision was 2B in 4 hips, 2C in one, 3A in 3 and 3B in 22. Regenerex augments were used in 39 hips and trabecular metal augments were used in 2. Thirty-six cups were cemented and 5 cups were uncemented. Mean follow-up was 37.6 months (range, 1–82). Radiographic findings of osteointegration between host bone and the porous metal augments were assessed. The presence or absence of radiolucent lines between cement or cup/host bone and augment/host bone interface was noted. Two revisions were performed due to infection, one month and 66 months after operation. The other implants were stable without any complications. Osteointegration between host bone and the porous metal augments were recognized in 36 hips. Radiolucent lines between cement/host bone interface, less than 1 mm in width, were visualized in 2 hips. Porous metal augments are convenient and our short-term results showed excellent radiological results for massive acetabular bone defects in primary and revision THA

Aims. The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky IIIA and IIIB defects. Patients and Methods. A retrospective study was conducted at four centres between August 2008 and January 2015. Patients treated with TM augments and TM shell for a Paprosky grade IIIA or IIIB defect, in the absence of pelvic discontinuity, and who underwent revision hip arthroplasty with the use of TM augments were included in the study. A total of 41 patients with minimum follow-up of two years were included and evaluated using intention-to-treat analysis. Results. There were 36 (87.8%) patients with a Paprosky IIIA defect and five (12.2%) patients with a Paprosky IIIB defect. The mean age was 56.7 years (28 to 94). There were 21 (51.2%) women and 20 (48.8%) men. The mean follow-up was 39.4 months (12 to 96). One (2%) patient died after eight years. No failures were noted in the series. The mean survivorship was 100% at the time of latest follow-up. Conclusion. The results of this multicentre study showed encouraging short- and mid-term results for the use of TM augments in the management of Paprosky grade IIIA and IIIB defects. Cite this article: Bone Joint J 2018;100-B:903–8

Aims

The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum.

Uncontained acetabular defects with loss of superior iliac and posterior column support (Paprosky 3) represent a reconstructive challenge as the deficient bone will preclude the use of a conventional hemispherical cup. Such defects can be addressed with large metallic constructs like cages with and without allograft, custom tri-flange cups, and more recently with trabecular metal augments. An underutilised alternative is impaction bone grafting, after creating a contained cavitary defect with a reinforcement mesh. This reconstructive option delivers a large volume of bone while using a small-size socket fixed with acrylic cement. Between 2005 and 2014, 21 patients with a Paprosky 3B acetabular defect were treated with cancellous, fresh frozen impaction grafting supported by a peripheral reinforcement mesh secured to the pelvis with screws. A cemented all-polyethylene cup was used. Pre-operative diagnosis was aseptic loosening (15 cemented and 6 uncemented). The femoral component was revised in 10 patients. Post-operative course consisted of 3 months of protected weight bearing. Patients were followed clinically and radiographically. One patient had an incomplete post-operative sciatic palsy. After a mean follow up of 47 months (13 to 128) none of the patients required re-revision of the acetabular component. One asymptomatic patient presented with aseptic loosening 9 years post-operatively. Hardware failure was not observed. All patients had radiographic signs of graft incorporation and bone remodeling. There were no dislocations. The early and mid-term results of revisions of large acetabular defects with this technique are encouraging. Reconstitution of hip center of rotation and bone stock with the use of a small-size implant makes this technique an attractive option for large defects. Longer follow-up is needed to assess survivability

The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky 3A, 3B defects and defects associated with pelvic discontinuity. A retrospective study was conducted of the cases performed at four centers between August 2007 and January 2015. Patients treated with TM augments for Paprosky 3A, 3B or chronic pelvic discontinuity were included in the study. All surgeries were performed through a posterior approach. A total of 57 patients (Male 34 (69%), Female 23(31%)), mean age 54 years (range, 28–94 years), with minimum follow up of one-year were included and evaluated using intention to treat analysis. There were 44 (77%) patients with a 3A defect, 11(19%) patients with a 3B defect (6 had an associated pelvic discontinuity), and 2 (3.5%) with a 2C defect and associated pelvic discontinuity. The mean follow-up was 37 months (range, 12–96 months). One (2%) patient died after 8 years of unrelated causes. Three (5.5%) patients had acetabular component loosening requiring revision; Two failures were (3.5%) due to aseptic loosening and one (2%) due to septic loosening. Fifty-four patients had a radiologically stable integration of the components at latest follow-up - survivorship was 94.7%. The results of this multi-center study demonstrate encouraging short and mid-term results for the use of TM augments in the management of Grade 3A and 3B defects, and defects associated with a chronic pelvic discontinuity

Aims. To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. . Patients and Methods. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). Results. The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (> /< one year), and age (> /< 55 years) had no significant effect on OHS or ten-year survival. Six THAs were revised at mean of 12 years (5 to 23) with ten-year all-cause survival of 92% (95% confidence interval 80.8 to 100). THA complication rates (all complications, heterotopic ossification, leg length discrepancy > 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 versus 40.2, p = 0.026); and final follow-up OHS (33.6 versus 40.9, p = 0.008). . Conclusion . Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399–1408

The indications for cementless acetabular fixation have been broadened because our data supports the use of trabecular metal cups even when there's limited bleeding host bone contact. Trabecular metal augments have allowed us to use cementless cups when there is segmental loss of bone. Surgical Technique: The acetabular bed is prepared. If there is less medial bone stock than 2mm, then morselised allograft is impacted by reverse reaming. When reaming is complete and less than 50% bleeding host bone is available for cup stabilisation, then a trabecular metal cup is indicated. Trabecular augments are used if the trabecular cup trial is not stable, or if it is uncovered by 40% or more. The conventional augments come in different sizes to accommodate the diameter of the cup and the size of the defect. Larger defects are addressed with anterior and posterior column augments, and superior defects with figure of seven augments. Augments are fixed with at least two screws. The interface between the cup and the augments should be stable, but some surgeons place a very thin layer of cement between the augment and cup so micromotion does not occur while ingrowth is occurring. We have used trabecular metal augments in 46 acetabular revisions in conjunction with a trabecular metal cup. Thirty-four cases have at least 2 years follow-up with an average of 64.5 months. There have been 4 cup loosenings with 3 re-revisions

The indications for cementless acetabular fixation have been broadened because our data supports the use of trabecular metal cups even when there's limited bleeding host bone contact. Trabecular metal augments have allowed us to use cementless cups when there is segmental loss of bone. Surgical Technique: The acetabular bed is prepared. If there is less medial bone stock than 2 mm, then morselised allograft is impacted by reverse reaming. When reaming is complete and less than 50% bleeding host bone is available for cup stabilization, then a trabecular metal cup is indicated. Trabecular augments are used if the trabecular cup trial is not stable, or if it is uncovered by 40% or more. The conventional augments come in different sizes to accommodate the diameter of the cup and the size of the defect. Larger defects are addressed with anterior and posterior column augments, and superior defects with figure of seven augments. Augments are fixed with at least two screws. The interface between the cup and the augments should be stable, but some surgeons place a very thin layer of cement between the augment and cup so micromotion does not occur while ingrowth is occurring. We have used trabecular metal augments in 46 acetabular revisions in conjunction with a trabecular metal cup. Thirty-four cases have at least 2 years follow-up with an average of 64.5 months. There has been 4 cup loosenings with 3 re-revisions. Our most up to date data is 101 cases with an average follow-up of 3 years. There has been one infection that underwent a two stage revision. There are 4 loose cups – 3 revised

Although total hip arthroplasty is highly successful for treatment of osteoarthrosis of hip joint, it is skill demanding surgery to perform and even more challenging in case of revision with bone defects. There are many options available for reconstruction of acetabular bony defects. Here, we evaluate the outcome of acetabular bony defect reconstructed with trabecular metal augments in short term. We performed, 22 revision total hip arthroplasties and 6 primary total hip arthroplasties (total 28 in 28 patients) using trabecular metal augments to reconstruct acetabular defect between 2011 to 2015. Out of these 28 patients, 18 were males and 10 were females. Mean age of these patients was 61.2 years (range: 46 years to 79 years). Pre-operative templating was done for all cases and need for trabecular metal augments was anticipated in all cases. All cases were classified according to Paprosky classification for acetabular bone defects. Out of 28 patients, 3 had type 2B, 1 had type 2C, 18 had type 3A and 6 had type 3B acetabular defects. Post operatively, all patients were followed at regular interval for their clinical and radiological outcome. An average follow up was 20.1 months (range: 6 months to 42.5 months). We assessed clinical outcome in the form of Herris hip score (HHS) and radiological outcomes in form of osteolysis in acetabular zones and osseointegration, according to the criteria of Moore. The average Harris hip score (HHS) was improved from 58.0 preoperatively to 87.2 postoperatively. The average degree of cup abduction at the final follow up was 44.29. The centre of rotation of the hip joint was corrected from average 38.90mm (range: 22.15mm to 66.35mm) above the inter-teardrop line preoperatively to average 23.85mm (range: 11.82mm to 37.69mm) above the inter-teardrop line postoperatively. Out of 28 patients, 18 patients had three or more signs of osseointegration, according to the criteria of Moore, at the time of final follow up. Rest of patients, had one or two signs of osseointegration (5 patients had one sign and 5 patients had two signs). We had no patient with migration or loosening of acetabular components. No patient has osteolysis of acetabulum in any zone. Trabecular metal augments provide good initial stability to acetabular cup as well as helpful to bring down the centre of rotation of the hip joint within limit of 35mm above the inter-teardrop line. They also facilitate osseointegration. Our study showed that the results of the trabecular metal augments in reconstruction of acetabular bony defects were successful even in short term. However, long term study is required for better evaluation

Uncontained acetabular defects with loss of superior iliac and posterior column support (Paprosky 3B) represent a reconstructive challenge as the deficient bone will preclude the use of a conventional hemispherical cup. Such defects can be addressed with large metallic constructs like cages with and without allograft, custom tri-flange cups, and more recently with trabecular metal augments. An underutilised alternative is impaction bone grafting, after creating a contained cavitary defect with a reinforcement mesh. This reconstructive option delivers a large volume of bone while using a small-size socket fixed with acrylic cement. Between 2006 and 2014, sixteen patients with a Paprosky 3B acetabular defect were treated with cancellous, fresh frozen impaction grafting supported by a peripheral reinforcement mesh secured to the pelvis with screws. A cemented all polyethylene cup was used. Preoperative diagnosis was aseptic loosening (10 cemented and 6 non-cemented). The femoral component was revised in 9 patients. Postoperative course consisted of 3 months of protected weight bearing. Patients were followed clinically and radiographically. One patient had an incomplete postoperative sciatic palsy. After a mean follow up of 40 months (24 to 104) none of the patients required re-revision. One asymptomatic patient presented with aseptic loosening 9 years postoperatively. Hardware failure was not observed. All patients had radiographic signs of graft incorporation and bone remodeling. There were no dislocations. The early and mid-term results of revisions for large acetabular defects with this technique are encouraging. Reconstitution of hip center of rotation and bone stock with the use of a small-size implant make this technique an attractive option for these large defects. Longer follow-up is needed to assess survivability