Aims. To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with
We report 11 patients having revision of total hip arthroplasty using massive
An uncemented hemispherical acetabular component
is the mainstay of acetabular revision and gives excellent long-term
results. Occasionally, the degree of acetabular bone loss means that a
hemispherical component will be unstable when sited in the correct
anatomical location or there is minimal bleeding host bone left
for biological fixation. On these occasions an alternative method
of reconstruction has to be used. A major column
Aims. It may not be possible to undertake revision total hip arthroplasty
(THA) in the presence of massive loss of acetabular bone stock using
standard cementless hemispherical acetabular components and metal
augments, as satisfactory stability cannot always be achieved. We
aimed to study the outcome using a reconstruction cage and a porous
metal augment in these patients. Patients and Methods. A total of 22 acetabular revisions in 19 patients were performed
using a combination of a reconstruction cage and porous metal augments.
The augments were used in place of
We retrospectively reviewed 44 consecutive patients
(50 hips) who underwent acetabular re-revision after a failed previous
revision that had been performed using structural or morcellised
allograft bone, with a cage or ring for uncontained defects. Of
the 50 previous revisions, 41 cages and nine rings were used with
allografts for 14 minor-column and 36 major-column defects. We routinely
assessed the size of the acetabular bone defect at the time of revision
and re-revision surgery. This allowed us to assess whether host
bone stock was restored. We also assessed the outcome of re-revision
surgery in these circumstances by means of radiological characteristics,
rates of failure and modes of failure. We subsequently investigated
the factors that may affect the potential for the restoration of bone
stock and the durability of the re-revision reconstruction using
multivariate analysis. At the time of re-revision, there were ten host acetabula with
no significant defects, 14 with contained defects, nine with minor-column,
seven with major-column defects and ten with pelvic discontinuity.
When bone defects at re-revision were compared with those at the
previous revision, there was restoration of bone stock in 31 hips, deterioration
of bone stock in nine and remained unchanged in ten. This was a
significant improvement (p <
0.001). Morselised allografting
at the index revision was not associated with the restoration of
bone stock. . In 17 hips (34%), re-revision was possible using a simple acetabular
component without allograft, augments, rings or cages. There were
47 patients with a mean follow-up of 70 months (6 to 146) available
for survival analysis. Within this group, the successful cases had
a minimum follow-up of two years after re-revision. There were 22 clinical
or radiological failures (46.7%), 18 of which were due to aseptic
loosening. The five and ten year Kaplan–Meier survival rate was
75% (95% CI, 60 to 86) and 56% (95% CI, 40 to 70) respectively with
aseptic loosening as the endpoint. The rate of aseptic loosening
was higher for hips with pelvic discontinuity (p = 0.049) and less
when the allograft had been in place for longer periods (p = 0.040). . The use of a cage or ring over
We investigated the early results of modular porous metal components used in 23 acetabular reconstructions associated with major bone loss. The series included seven men and 15 women with a mean age of 67 years (38 to 81), who had undergone a mean of two previous revisions (1 to 7). Based on Paprosky’s classification, there were 17 type 3A and six type 3B defects. Pelvic discontinuity was noted in one case. Augments were used in 21 hips to support the shell and an acetabular component-cage construct was implanted in one case. At a mean follow-up of 41 months (24 to 62), 22 components remained well fixed. Two patients required rerevision of the liners for prosthetic joint instability. Clinically, the mean Harris Hip Score improved from 43.0 pre-operatively (14 to 86) to 75.7 post-operatively (53 to 100). The mean pre-operative Merle d’Aubigné score was 8.2 (3 to 15) and improved to a mean of 13.7 (11 to 18) post-operatively. These short-term results suggest that modular porous metal components are a viable option in the reconstruction of Paprosky type 3 acetabular defects. More data are needed to determine whether the system yields greater long-term success than more traditional methods, such as reconstruction cages and
There are few medium- and long-term data on the outcome of the use of proximal femoral
We retrospectively reviewed 40 hips in 36 patients who had undergone acetabular reconstruction using a titanium Kerboull-type acetabular reinforcement device with bone allografts between May 2001 and April 2006. Impacted bone allografts were used for the management of American Academy of Orthopaedic Surgeons Type II defects in 17 hips, and bulk bone allografts together with impacted allografts were used for the management of Type III defects in 23 hips. A total of five hips showed radiological failure at a mean follow-up of 6.7 years (4.5 to 9.3), two of which were infected. The mean pre-operative Merle d’Aubigné score was 10 (5 to 15) vs 13.6 (9 to 18) at the latest follow-up. The Kaplan-Meier survival rate at ten years, calculated using radiological failure or revision of the acetabular component for any reason as the endpoint, was 87% (95% confidence interval 76.3 to 97.7). A separate experimental analysis of the mechanical properties of the device and the load-displacement properties of bone grafts showed that a
The conventional method for reconstructing acetabular
bone loss at revision surgery includes using
Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS). Retrospectively collected data of 38 patients (39 hips) with pelvic discontinuity treated with revision THA using a custom-made triflange acetabular component were analyzed. Minimum follow-up was two years (mean 5.1 years (2 to 11)).Aims
Methods
The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA. A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.Aims
Methods
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. In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis.Aims
Methods
This single-centre observational study aimed to describe the results of extensive bone impaction grafting of the whole acetabular cavity in combination with an uncemented component in acetabular revisions performed in a standardized manner since 1993. Between 1993 and 2013, 370 patients with a median age of 72 years (interquartile range (IQR) 63 to 79 years) underwent acetabular revision surgery. Of these, 229 were more than ten years following surgery and 137 were more than 15 years. All revisions were performed with extensive use of morcellized allograft firmly impacted into the entire acetabular cavity, followed by insertion of an uncemented component with supplementary screw fixation. All types of reoperation were captured using review of radiographs and medical charts, combined with data from the local surgical register and the Swedish Hip Arthroplasty Register.Aims
Methods
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. 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.Aims
Patients and Methods
Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems. We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).Aims
Patients and Methods
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. We identified 36 patients (37 hips) who underwent revision THA
under these circumstances using the KARD, fresh frozen allograft
femoral heads, and reconstruction of the inferior margin of the
acetabulum. The Merle d’Aubigné system was used for clinical assessment.
Serial anteroposterior pelvic radiographs were used to assess migration
of the acetabular component.Aims
Patients and Methods
A number of studies have reported satisfactory
results from the isolated revision of an acetabular component. However,
many of these studies reported only the short- to intermediate-term
results of heterogeneous bearing surfaces in a mixed age group. We present our experience of using a ceramic-on-ceramic (CoC)
bearing for isolated revision of an uncemented acetabular component
in 166 patients (187 hips) who were under the age of 50 years at
the time of revision. There were 78 men and 88 women with a mean
age of 47.4 years (28 to 49). The most common reason for revision
was polyethylene wear and acetabular osteolysis in 123 hips (66%),
followed by aseptic loosening in 49 hips (26%). We report the clinical and radiological outcome, complication
rate, and survivorship of this group. The mean duration of follow-up
was 15.6 years (11 to 19). The mean pre-operative Harris hip score was 33 points (1 to 58),
and improved to a mean of 88 points (51 to 100) at follow-up. The
mean pre-operative total Western Ontario and McMaster Universities
Osteoarthritis Index score was 63.2 (43 to 91) and improved to 19.8
points (9 to 61) post-operatively. Overall, 153 of 166 patients
(92%) were satisfied with their outcome. Kaplan–Meier survivorship
analysis, with revision or radiological evidence of implant failure
(13 patients, 8%) as end-points, was 92% at 15 years (95% confidence
interval 0.89 to 0.97). Isolated revision of a cementless acetabular component using
a CoC bearing gives good results in patients under 50 years of age. Cite this article:
In order to address acetabular defects, porous metal revision acetabular components and augments have been developed, which require fixation to each other. The fixation technique that results in the smallest relative movement between the components, as well as its influence on the primary stability with the host bone, have not previously been determined. A total of 18 composite hemipelvises with a Paprosky IIB defect were implanted using a porous titanium 56 mm multihole acetabular component and 1 cm augment. Each acetabular component and augment was affixed to the bone using two screws, while the method of fixation between the acetabular component and augment varied for the three groups of six hemipelvises: group S, screw fixation only; group SC, screw plus cement fixation; group C, cement fixation only. The implanted hemipelvises were cyclically loaded to three different loading maxima (0.5 kN, 0.9 kN, and 1.8 kN).Objectives
Methods
Few reconstructive techniques are available for patients requiring
complex acetabular revisions such as those involving Paprosky type
2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was
to describe the development of the patient specific Triflange acetabular
component for use in these patients, the surgical technique and
mid-term results. We include a description of the pre-operative
CT scanning, the construction of a model, operative planning, and
surgical technique. All implants were coated with porous plasma
spray and hydroxyapatite if desired. A multicentre, retrospective review of 95 complex acetabular
reconstructions in 94 patients was performed. A total of 61 (64.2%)
were female. The mean age of the patients was 66 (38 to 85). The
mean body mass index was 29 kg/m2 (18 to 51). Outcome
was reported using the Harris Hip Score (HHS), complications, failures
and survival.Aims
Patients and Methods
The use of ilioischial cage reconstruction for
pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer,
Warsaw, Indiana) cup-cage technique in our institution, due to the
unsatisfactory outcome of using a cage alone in this situation.
We report the outcome of 26 pelvic discontinuities in 24 patients
(20 women and four men, mean age 65 years (44 to 84)) treated by
the cup-cage technique at a mean follow-up of 82 months (12 to 113)
and compared them with a series of 19 pelvic discontinuities in
19 patients (18 women and one man, mean age 70 years (42 to 86))
treated with a cage at a mean follow-up of 69 months (1 to 170).
The clinical and radiological outcomes as well as the survivorship
of the groups were compared. In all, four of the cup-cage group
(15%) and 13 (68%) of the cage group failed due to septic or aseptic
loosening. The seven-year survivorship was 87.2% (95% confidence interval
(CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84)
for the cage-alone group (p = 0.009). There were four major complications
in the cup-cage group and nine in the cage group. Radiological union
of the discontinuity was found in all successful cases in the cup-cage
group and three of the successful cage cases. Three hips in the
cup-cage group developed early radiological migration of the components,
which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating
pelvic discontinuity in mid-term follow-up and is preferred to ilioischial
cage reconstruction. If the continuity of the bone graft at the
discontinuity site is not disrupted, early migration of the components
does not necessarily result in failure. Cite this article: