Introduction. The mid- or long-term results of acetabular revision total hip arthroplasty (THA) in Korea are rare. The purpose of this study is to report the mid-term radiographic results (> 5 years) of acetabular revision THA with porous-coated cementless Trilogy. ®. cup (Zimmer, Warsaw, IN, USA). Materials and Methods. Between 1999 and 2010, 77 patients (79 hips) had underwent acetabular revision THA with Trilogy. ®. cup. Eight patients (8 hips) were excluded due to death before 5-year follow-up, and 22 patients (23 hips) were excluded due to less than 5-year follow-up or follow-up loss. Forty-seven patients (48 hips) were included in our study. The mean age was 57.9 years (range, 36 to 76 years) and the mean follow-up was 9.8 years (range 5.0 to 16.2 years). The causes of revision were aseptic loosening in 40 hips, and septic loosening in 8 hips, respectively. Both acetabular and femoral revisions were performed in 14 hips and isolated acetabular revision was done in 34 hips. Preoperetive acetabular bone defect according to Paprosky classification was; 1 in type I, 6 in IIA, 11 in IIB, 9 in IIC, 15 in IIIA, and 6 in IIIB. Results. Radiolucent lines less than 2mm were found in 2 hips; one in zone I, another in zone I, II, III. Four hips (1 in type IIC, 1 in IIIA and 2 in IIIB) showed cup migration greater than 5 mm accompanying change of position greater than 5 degrees. However, these patients did not complain pain and showed fixation by secondary stabilization. The Kaplan-Meier survivorship with aseptic loosening as the end point at 10 years was 92.6% (95% confidence interval [CI], 82.6 – 100) and at 15 years was 83.8 % (95% CI, 69.1 – 98.6), respectively. Non-recurrent dislocations occurred in 4 hips. There were no other complication such as sciatic nerve palsy, infection and deep vein thrombosis. Conclusion. Mid-term radiographic results (>5 years) of acetabular revision THA with porous-coated cementless Trilogy. ®. cup showed durable longevity. However, other options such as anti-protrusio cage or cup-cage construct should be considered in severe acetabular bone defect

Introduction:. Jumbo cups (58 mm or larger diameter in females and 62 mm or larger diameter in males), theoretically have lowered the percentage of bleeding bone that is required for osseointegration in severe acetabular defects. The purpose of this study was to analyze the safety and efficacy of Tritanium jumbo cups in patients with major acetabular defects (Paprosky type IIIa and IIIb) and assess the extent of osseointegration. Material and Methods:. From February 2007 and August 2010, 28 consecutive hips (26 patients, mean age of 69 years) underwent acetabular revision arthroplasty for treatment of Paprosky type IIIa and IIIb defects using Tritanium jumbo cups (Stryker, Mahwah, New Jersey). Results:. 14% of the hips had pelvic discontinuity. There was no intra-operative fracture. The initial stability was achieved in all hips, supplemented by screws. No Tantalum augments or bulk bone grafts were used in any of the cases. At mean follow-up of 4 years, there were no failures due to loosening or cup migration. Radiographic assessment showed osseointegration in all cups, ranging from 30% to 75% of the cup surface area as assessed in both anteroposterior and false profile views in Charnley zones I through VI. Discussion and conclusion:. In Paprosky type IIIb defect with pelvic discontinuity, jumbo cup can be used safely without the use of any augments. In pelvic dissociation, the fibrous tissue is stretched with jumbo cups in an under-reamed socket to achieve a fixation by distraction, especially in failed cemented sockets

We reviewed 81 consecutive ABG primary total hip replacements in 72 patients operated between January 1993 to December 1998. The mean follow-up was 8.2 years (7 to 12 years). The mean age of the patients was 52 years (range: 28 to 65 years). The mean pre-operative Harris hip score of 42 (range: 24 to 48) improved to a post-operative 80 (range: 58 to 86). At the latest follow-up 2 patients had died through causes not related to surgery. 3 cups had been revised for aseptic loosening. However, 69 of the remaining 75 acetabular cups showed excessive superolateral wear of polyethylene liner. The wear was most pronounced in cups size 46 with a 28 mm head. 16 of the acetabular cups showed significant osteolysis in zone I and II of the acetabulum (Gruen) and are awaiting a revision. None of the stems has been revised to date. The cumulative survival of prosthesis is as follows:. Stem survival with revision being the end point: 100%. Acetabular cups with revision & aseptic loosening: 72% (95% CI: 61 to 78%). Acetabular liner with significant wear: 32% (95% CI: 28 to 52%). The failure of cups is related to the poor locking mechanism of the polyethylene liner. In spite of significant radiological failures of the cups most patients continued to have good Harris hip scores and remained fairly asymptomatic. The results of ABG stem in this series are good but in view of the cup failures we now no longer use the ABG I cups but advocate a long term regular follow-up of these hips

Purpose. This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. Materials and Methods. The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10–15 years). Result. The average Harris hip score was 87.3 (range77-94) points at the final follow-up. Hip scores at the last follow-up were; excellent in 32 out of 45 hips(71.1%), good in 10 (22.2%) hips and fair in 3(6.7%) hips. The prevalence of thigh pain was initially 15.6%(7 hips) and the pain in all hips disappeared 3 years after surgery. Thirty-eight (84.4%) stems had good canal fill; 37 hips of these showed bone ingrowth and one hip had stable fibrous ingrowth. Seven (15.6%) hips had a poor canal fill. Four of these showed bone ingrowth, and 3 hips showed stable fibrous ingrowth. There was no unstable stem. Osteolysis was observed around the stem in 20 hips(44.4%) and around the cup in 26 hips(57.8%). Most of the osteolysis in the femoral side was in zones I and VII. Stress-mediated femoral resorption was observed in 30 hips at 3 years after surgery, 32 hips at 5 years after surgery and 33 hips (73.3%) at 10 years after surgery: first degree in 15 hips(33.3%), second degree in 11 hips (24.4%) and third degree in 7 hips(15.6%), respectively. The demographic data (age, weight and stem size) of the 35 hips showing evidence of stress shielding were compared with the group not showing stress shielding. There was no apparent difference between the two groups. The resorption did not progress to the third degree from either the first or second degree after 5 years postoperatively. There was no stem loosening. Four hips were revised. One hip was revised at 5 years after surgery because of an unstable fixation of the acetabular component. Three hips were revised due to osteolysis around the cup and excessive polyethylene wear; posteoperative 10 years in two hips and 11 years in one hip. Conclusion. The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption