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Ilo KC, Van Duren BH, Berber R, Matar HE, Manktelow ARJ, Bloch BV. Comparing Trabecular Metal Versus Fiber Mesh Cementless Acetabular Components: A Single-Center Study of 6,563 Hips. J Arthroplasty 2025; 40:1589-1593. [PMID: 39581240 DOI: 10.1016/j.arth.2024.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 11/15/2024] [Accepted: 11/19/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Trabecular metal is being increasingly used in primary total hip arthroplasty (THA). This study compared medium-term (< 15 years) outcomes of fiber mesh titanium and trabecular metal acetabular components. METHODS This study included 6,563 patients who underwent primary THA with either fiber mesh titanium or trabecular metal-backed acetabular components. Data were sourced from a prospectively maintained local arthroplasty database and linked with the National Joint Registry. RESULTS The 10-year survivorship was 97.3% for fiber mesh and 98.9% for porous tantalum groups (P = 0.009). Multivariate analysis showed no significant variable associated with reduced revision rates. CONCLUSIONS Both fiber mesh titanium and trabecular metal acetabular components demonstrated high survivorship in THA, with trabecular metal showing statistically significant though marginally better survival. Despite the increased cost associated with trabecular metal, its use may be justified in complex primary and revision cases where increased primary stability may be required. Future research should focus on cost analysis and include patient-reported outcomes to guide implant selection further.
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Affiliation(s)
- Kevin C Ilo
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Bernard H Van Duren
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals, Nottingham, United Kingdom; University of Nottingham, Nottingham, United Kingdom
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Frieler S, Gebert C, Hanusrichter Y, Godolias P, Wessling M. The Modified Harrington Procedure for Metastatic Peri-Acetabular Bone Lesion Using a Novel Highly Porous Titanium Revision Shell with Long Lever Arm Screw. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1047. [PMID: 39064480 PMCID: PMC11279007 DOI: 10.3390/medicina60071047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Peri-acetabular metastases often lead to significant pain and functional impairment. Surgical interventions, including the Harrington procedure, aim to address these challenges. This study evaluates a modified Harrington procedure using the MUTARS® PRS® (Pelvic Revision Shell) with an 8 mm fixation screw for severe acetabular defects resulting from metastatic lesions. Materials and Methods: Retrospective analysis of 12 patients treated between January 2020 and December 2023 was conducted. The procedure involved using the novel MUTARS® PRS® with an 8 mm in diameter dome screw (length 70-100 mm). Outcome measures included implant positioning changes, complication rates, functional outcomes, implant longevity, and patient survival. Radiological assessments were performed postoperatively, with follow-ups at 3, 6, 12 months, and annually thereafter. Results: Average follow-up was 15 ± 11 months, with 67% patient survival at 1 year and 44% at 2 years. Implant survivorship remained 100%. Harris Hip Score improved significantly from 37 ± 22 preoperatively to 75 ± 15 at the last follow-up. No revisions involving implant components were reported. Complications occurred in 5 of 12 patients. Overall, PRS® demonstrates effective osseous ingrowth, high primary stability, immediate full weight-bearing, and low complication rates. Conclusions: PRS® integrates facilitating osseous ingrowth for preferable long-term outcomes, while efficiently transmitting the weight-bearing load to the intact aspect of the pelvis using a long 8 mm lever screw, enhancing the primary stability of the construct. It proves to be an effective and reproducible technique for managing destructive metastatic lesions of the acetabulum and peri-acetabular region, even in irradiated bone.
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Affiliation(s)
- Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Department of Trauma and Orthopaedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
- Seattle Science Foundation, Seattle, WA 98122, USA
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, Germany
| | - Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
| | - Periklis Godolias
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, 45239 Essen, Germany
| | - Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, 58300 Wetter, Germany
- Center for Musculoskeletal Surgery, University Hospital of Essen, 45147 Essen, Germany
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Mirghaderi P, Eshraghi N, Sheikhbahaei E, Razzaghof M, Roustai-Geraylow K, Pouramini A, Eraghi MM, Kafi F, Javad Mortazavi SM. Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 25:101293. [PMID: 38298809 PMCID: PMC10827600 DOI: 10.1016/j.artd.2023.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Studies suggest tantalum (Ta) implants may have inherent antibacterial properties. However, there is no consensus regarding the effectiveness of Ta in preventing periprosthetic joint infection (PJI) after revision total hip arthroplasty (rTHA). METHODS We searched 5 main databases for articles reporting the rate of PJI following rTHA using Ta implants from inception to February 2022. The PJI rates of the Ta group were meta-analyzed, compared with the control group, and represented as relative risks (RRs) in forest plots. RESULTS We identified 67 eligible studies (28,414 joints) for assessing the prevalence of PJI following rTHA using Ta implants. Among these studies, only 9 compared the Ta implant group with a control group. The overall PJI rate following rTHA using Ta implants was 2.9% (95% confidence interval [CI]: 2.2%-3.8%), while it was 5.7% (95% CI = 4.1%-7.8%) if only septic revisions were considered. Comparing the Ta and control groups showed a significantly lower PJI rate following all-cause rTHA with an RR = 0.80 (95% CI = 0.65-0.98, P < .05). There was a trend toward lower reinfection rates in the Ta group after rTHA in septic cases, although the difference was not statistically significant (RR = 0.75, 95% CI = 0.44-1.29, P = .30). CONCLUSIONS Ta implants are associated with a lower PJI rate following all-cause rTHA but not after septic causes. Despite positive results, the clinical significance of Ta still remains unclear since the PJI rate was only reduced by 20%. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Peyman Mirghaderi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Eshraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kiarash Roustai-Geraylow
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mirahmadi Eraghi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kafi
- Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Marin E. Forged to heal: The role of metallic cellular solids in bone tissue engineering. Mater Today Bio 2023; 23:100777. [PMID: 37727867 PMCID: PMC10506110 DOI: 10.1016/j.mtbio.2023.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
Metallic cellular solids, made of biocompatible alloys like titanium, stainless steel, or cobalt-chromium, have gained attention for their mechanical strength, reliability, and biocompatibility. These three-dimensional structures provide support and aid tissue regeneration in orthopedic implants, cardiovascular stents, and other tissue engineering cellular solids. The design and material chemistry of metallic cellular solids play crucial roles in their performance: factors such as porosity, pore size, and surface roughness influence nutrient transport, cell attachment, and mechanical stability, while their microstructure imparts strength, durability and flexibility. Various techniques, including additive manufacturing and conventional fabrication methods, are utilized for producing metallic biomedical cellular solids, each offering distinct advantages and drawbacks that must be considered for optimal design and manufacturing. The combination of mechanical properties and biocompatibility makes metallic cellular solids superior to their ceramic and polymeric counterparts in most load bearing applications, in particular under cyclic fatigue conditions, and more in general in application that require long term reliability. Although challenges remain, such as reducing the production times and the associated costs or increasing the array of available materials, metallic cellular solids showed excellent long-term reliability, with high survival rates even in long term follow-ups.
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Affiliation(s)
- Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585, Kyoto, Japan
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
- Department Polytechnic of Engineering and Architecture, University of Udine, 33100, Udine, Italy
- Biomedical Research Center, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
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Bellova P, Reich MC, Grothe T, Günther KP, Stiehler M, Goronzy J. Treatment of Severe Acetabular Defects With an Antiprotrusio Cage and Trabecular Metal Augments - Clinical and Radiographic Results After a Mean Follow-Up of 6.6 Years. J Arthroplasty 2023; 38:2415-2422. [PMID: 37271233 DOI: 10.1016/j.arth.2023.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Large acetabular bone defects present a serious challenge in revision total hip arthroplasty. The off-label use of antiprotrusio cages in combination with tantalum augments is a promising treatment option in these difficult situations. METHODS Between 2008 and 2013, 100 consecutive patients underwent acetabular cup revision with a cage-augment combination in Paprosky 2 and 3 defect types (including pelvic discontinuities). There were 59 patients available for follow-up. The primary endpoint was the explantation of the cage-and-augment construct. The secondary endpoint was acetabular cup revision for any reason. Also, radiographic and functional outcomes (Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score) were evaluated. Implant survival rates were determined using a Kaplan-Meier analysis. The significance level was set at P < .05. RESULTS Explantation-free survivorship of the "Cage-and-Augment" system was 91.9% after a mean follow-up of 6.2 years (range, 0 to 12.8). All 6 explantations were due to periprosthetic joint infection (PJI). The overall revision-free implant survival rate was 85.7%, including 6 additional liner revisions due to instability. In addition, 6 early PJI occurred, which were successfully treated with debridement, irrigation, and implant retention. We did observe one patient who had radiographic loosening of the construct without necessity for treatment. CONCLUSION The combination of an antiprotrusio cage with tantalum augments is a promising technique in treating large acetabular defects. A major risk of PJI and instability due to large bone and soft tissue defects needs special attention.
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Affiliation(s)
- Petri Bellova
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Tim Grothe
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Peter Günther
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Maik Stiehler
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens Goronzy
- Center of Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
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Kim HS, Kim JW, Chang JS, Kim CH. Revision Total Hip Arthroplasty Utilizing an Acetabular Reinforcement Ring with a Metal Augment: A Minimum Eight-Year Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1036. [PMID: 37374240 DOI: 10.3390/medicina59061036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: An acetabular reinforcement ring (ARR) with a structural allograft is conventionally used to treat large acetabular bone defects or discontinuity during revision hip arthroplasty. However, ARR is prone to failure due to bone resorption and lack of incorporation. Here, we investigated the surgical outcomes of the patients who underwent revision total hip arthroplasty (THA) using ARR combined with a metal augment (MA). Materials and Methods: We retrospectively reviewed data from 10 consecutive patients who had a minimum 8-year follow-up after revision hip arthroplasty using ARR with MA in Paprosky type III acetabular defect. We collected patient demographics, surgical details, clinical scores (including Harris Hip Score (HHS)), postoperative complications, and 8-year survival rates. Results: Six male and four female patients were included. The mean age was 64.3 years, and the mean follow-up duration was 104.3 months (96.0-112.0 months). Trauma-related diagnosis was the most common reason for index surgery. Three patients underwent all component revision, and seven underwent cup revision. Six were confirmed as Paprosky type IIIA and four as type IIIB. The mean HHS at the final follow-up was 81.5 (72-91). One patient was diagnosed with prosthetic joint infection at the 3-month follow-up; therefore, the minimum 8-year survival rate with our technique was 90.0% (95% confidence interval, 90.3-118.5%). Conclusions: The satisfactory mid- to long-term results of revision THA suggest that ARR combined with tantalum MA is a viable revision option for treating severe acetabular defects with pelvic discontinuity.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, National Police Hospital, Seoul 05715, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Tang H, Huang Y, Zhou Y, Ma Z, Guo S. Extended Fixation for Paprosky Type III Acetabular Defects in Revision Total Hip Arthroplasty with a Minimum Follow-Up of 2 Years. Orthop Surg 2022; 15:205-213. [PMID: 36419313 PMCID: PMC9837286 DOI: 10.1111/os.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Revision of total hip arthroplasty for patients with severe acetabular bone defects is challenging. This study aims to report the minimum 2 years outcome of the iliac extended fixation technique in patients with Paprosky type III acetabular defects. METHODS Fifty-seven revision total hip arthroplasty patients were retrospectively reviewed who underwent reconstruction with the concept of iliac extended fixation from 2014 to 2017 in our hospital. We proposed a new concept of "iliac extended fixation" in revision total hip arthroplasty as fixation extending superiorly 2 cm beyond the original acetabular rim with porous metal augments, which was further classified into intracavitary and extracavitary fixation. Patients were assessed using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index Score. Radiographs and patient-reported satisfaction were assessed. RESULTS At an average follow-up of 63 months (range 25-88 months), the postoperative Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly improved at the last follow-up (p < 0.001). The center of rotation was significantly improved (p < 0.05). Fifty-three (93.0%) patients were satisfied with the outcome. The extracavitary iliac extended fixation group had higher rate of osteointegration in zone 1A (the superior lateral zone) than the intracavitary iliac extended fixation group (82.3% vs 55.0%, p = 0.015), and significantly more horizontal screws fixation (5.1 ± 24.7° vs 42.3 ± 36.8°, p < 0.001). CONCLUSION Intracavitary and extracavitary iliac extended fixation with porous metal augments and cementless cups are effective in reconstructing severe superior acetabular bone defects. The difference in screw direction might reflect the different biomechanics of augment fixation.
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Affiliation(s)
- Hao Tang
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Yong Huang
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Yixin Zhou
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Zhuyi Ma
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
| | - Shengjie Guo
- Investigation performed at the Department of Orthopedic Surgery, Beijing Jishuitan HospitalFourth Clinical College of Peking UniversityBeijingChina
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Connors JP, Garvin P, Silver J, Lindsay A, Solovyova O. Acetabular fixation in total hip arthroplasty in the previously irradiated pelvis: a review of basic science and clinical outcomes. Arch Orthop Trauma Surg 2022; 143:3517-3524. [PMID: 35984490 DOI: 10.1007/s00402-022-04589-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
Radiation therapy is a common primary, adjuvant, or palliative treatment for many intrapelvic tumors, including primary gastrointestinal, genitourinary, and hematopoietic tumors, as well as metastatic disease to bone. Radiation has well documented microbiologic and clinical effects on bone ranging from radiation osteitis to early degenerative changes of the hip joint and avascular necrosis of the femoral head. Conventional total hip arthroplasty methods have demonstrated high rates of failure in this population, with historical data describing aseptic loosening rates as high as 44-52%, as radiation have been shown to preferentially diminish osteoblast and osteocyte number and function and limit capacity for both cement interdigitation and biologic bony ingrowth. A review of the clinical literature suggests that patients with prior pelvic irradiation are at higher risk for both septic and aseptic loosening of acetabular components, as well as lower postoperative Harris Hip Score (HHS) when compared to historical controls. With limited evidence, trabecular metal shells with multi-screw fixation and cemented polyethene liners, as well as cemented cup-cage constructs both appear to be durable acetabular fixation options, though the indications for each remains elusive. Further prospective data are needed to better characterize this difficult clinical problem.
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Affiliation(s)
- John Patrick Connors
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Patrick Garvin
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Jacob Silver
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Adam Lindsay
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - Olga Solovyova
- Department of Orthopaedic Surgery, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT, 06030, USA
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Gao X, Zhao Y, Wang M, Liu Z, Liu C. Parametric Design of Hip Implant With Gradient Porous Structure. Front Bioeng Biotechnol 2022; 10:850184. [PMID: 35651549 PMCID: PMC9150022 DOI: 10.3389/fbioe.2022.850184] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Patients who has been implanted with hip implant usually undergo revision surgery. The reason is that high stiff implants would cause non-physiological distribution loadings, which is also known as stress shielding, and finally lead to bone loss and aseptic loosening. Titanium implants are widely used in human bone tissues; however, the subsequent elastic modulus mismatch problem has become increasingly serious, and can lead to stress-shielding effects. This study aimed to develop a parametric design methodology of porous titanium alloy hip implant with gradient elastic modulus, and mitigate the stress-shielding effect. Four independent adjustable dimensions of the porous structure were parametrically designed, and the Kriging algorithm was used to establish the mapping relationship between the four adjustable dimensions and the porosity, surface-to-volume ratio, and elastic modulus. Moreover, the equivalent stress on the surface of the femur was optimized by response surface methodology, and the optimal gradient elastic modulus of the implant was obtained. Finally, through the Kriging approximation model and optimization results of the finite element method, the dimensions of each segment of the porous structure that could effectively mitigate the stress-shielding effect were determined. Experimental results demonstrated that the parameterized design method of the porous implant with gradient elastic modulus proposed in this study increased the strain value on the femoral surface by 17.1% on average. Consequently, the stress-shielding effect of the femoral tissue induced by the titanium alloy implant was effectively mitigated.
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Affiliation(s)
- Xiangsheng Gao
- Beijing Key Laboratory of Advanced Manufacturing Technology, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing, China.,Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Yuhang Zhao
- Beijing Key Laboratory of Advanced Manufacturing Technology, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing, China
| | - Min Wang
- Beijing Key Laboratory of Advanced Manufacturing Technology, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing, China
| | - Ziyu Liu
- Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, London, United Kingdom.,School of Engineering Medicine, Beihang University, Beijing, China
| | - Chaozong Liu
- Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, London, United Kingdom
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10
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Garala K, Boutefnouchet T, Amblawaner R, Lawrence T. Acetabular reconstruction using a composite layer of impacted cancellous allograft bone and cement: minimum 5-year follow-up study. Hip Int 2022; 32:197-204. [PMID: 32678673 DOI: 10.1177/1120700020941407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is often complex and has a less reliable outcome than primary total hip arthroplasty. Acetabular reconstruction remains a challenge because of the variable amount of bone loss. This study describes and evaluates a novel technique of acetabular reconstruction using composite bone grafting. PATIENTS AND METHODS Between June 2005 and January 2012, 108 consecutive patients underwent revision hip arthroplasty in which the acetabular component was revised using composite bone grafting. Of these, 24 were lost to follow-up leaving 84 in the study with a minimum 5-year follow-up. There were 54 women and 30 men with a mean age of 70.1 (31-91) years. All patients were assessed clinically and radiologically after a minimum of 5 years. The primary outcome measures were rate of re-revision, patient-reported outcomes and radiological evidence of loosening. RESULTS The mean follow-up after revision surgery was 6.9 years (5-10). At operation, 60 patients had an acetabular defect of AAOS stage 3 or more. There was no evidence of loosening in 69 revision acetabular components; 12 showed evidence of non-progressive loosening and 3 patients underwent a re-revision procedure (2 for infection, 1 recurrent dislocation).The mean postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) was 89.11/100 (95% CI, 87.8-90.5). Scores were significantly improved in patients with a more extensive preoperative defect (p = 0.006). The overall patient satisfaction rate at final follow-up was very high. CONCLUSIONS Composite impaction grafting using a layered cement and bone graft technique can give satisfactory clinical and radiological outcomes in the medium- to long-term.
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Affiliation(s)
- Kanai Garala
- Trauma and Orthopaedic Department, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Tarek Boutefnouchet
- Trauma and Orthopaedic Department, Birmingham Heartlands Hospital, Birmingham, UK
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11
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Maitama MI, Lawal YZ, Dahiru IL, Alabi IA, Amaefule KE, Audu SS, Ibrahim A. Implant factors that might influence components' survival in primary total hip arthroplasty. Niger Postgrad Med J 2022; 29:1-5. [PMID: 35102943 DOI: 10.4103/npmj.npmj_726_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Primary total hip arthroplasty (THA) is an invaluable surgical procedure that has revolutionised the treatment of various end-stage hip pathologies. Aseptic loosening of either acetabular cup and/or femoral stem as well as components' dislocation are well-known post-operative complications due to so many factors: environmental, surgeon, patient related, disease related or implant design. The aim of this literature review is to look at some relevant implant designs that might influence acetabular and femoral components' survival for primary cementless THA using revision for aseptic loosening and dislocation as criteria for failure. This may also assist the surgeon in making an informed choice of using appropriate implants to match the demographic and disease-specific need of the patients undergoing the surgical procedure. This review article was performed using an online literature search on relevant publications.
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Affiliation(s)
- Mohammed Inuwa Maitama
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Yau Zakari Lawal
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Ismaila Lawal Dahiru
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Ibrahim Abolaji Alabi
- Department of Trauma and Orthopedic Surgery, National Orthopedic Hospital Dala, Kano State, Nigeria
| | - Kenneth Ezenwa Amaefule
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Simpa Siaka Audu
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
| | - Aniko Ibrahim
- Department of Trauma and Orthopedic Surgery, Ahmadu Bello University Zaria, Kaduna State, Nigeria
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Cruz-Pardos A, García-Rey E, Fernandez-Fernández R, Ortega-Chamarro J. Do trabecular metal cups achieve better results when compared to hemispherical porous titanium cups in acetabular revision surgery? Hip Int 2021; 31:774-781. [PMID: 32363969 DOI: 10.1177/1120700020919943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Trabecular metal (TM) cups were introduced in order to achieve better ingrowth and stability of the cup in acetabular revision surgery. As their use has evolved over time, we have queried whether TM cups would improve results in terms of the rate of aseptic loosening when compared to historical uncemented porous titanium cups used in revision surgery for acetabular bone loss in Hospital La Paz (Madrid, Spain). METHODS We retrospectively reviewed 197 acetabular revisions performed between 1991 and 2015. Titanium cups were used in 81 cases and TM cups in 116. The mean follow-up was 8.1 years (range 1-15); 12.0 ± 7.8 for titanium group and 5.4 ± 3.1 for TM group. The most common reason for revision was aseptic loosening. A Kaplan-Meier analysis was used to determine the survival of the cup, with radiological failure and re-revision due to aseptic loosening as the endpoints. Cox multivariate regression analyses were performed to assess different risk factors for failure. RESULTS 1 TM cup and 1 titanium cup were re-revised due to aseptic loosening (p = 0.61). Radiological cup loosening was observed in 4 TM cups and 2 titanium cups (p = 1.0). At 6 years, the probability of not having radiological cup loosening was 97.4% (95% CI, 93.9-100) for the titanium cups and 95.1% for the TM cups (95% CI, 90.1-99.9) (p = 0.59). Another 5 cups were re-revised due to dislocation. Hips with a greater Paprosky defect showed a higher risk of loosening (p < 0.05, hazard risk (HR) 3.04; 95% CI, 0.97-9.54). CONCLUSIONS This study shows there was no significant difference in re-revision due to aseptic loosening or radiological loosening between titanium and TM cups in revision surgery for acetabular bone loss. Both types of cups demonstrate excellent results with a low failure rate and minimal complications.
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Bawale R, Choudhry B, Samsani S. Mid-term outcomes of tantalum cup- a single centre study. ARTHROPLASTY 2021; 3:42. [PMID: 35236498 PMCID: PMC8796520 DOI: 10.1186/s42836-021-00099-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.
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Affiliation(s)
- Rajesh Bawale
- Department of Trauma and Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham, ME7 5NY, UK. .,, Chigwell, UK.
| | - Baseem Choudhry
- Department of Trauma and Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham, ME7 5NY, UK
| | - Srinivasa Samsani
- Department of Trauma and Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham, ME7 5NY, UK
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Di Laura A, Henckel J, Wescott R, Hothi H, Hart AJ. The effect of metal artefact on the design of custom 3D printed acetabular implants. 3D Print Med 2020; 6:23. [PMID: 32845428 PMCID: PMC7450581 DOI: 10.1186/s41205-020-00074-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D Printed custom-made implants constitute a viable option in patients with acetabular Paprosky III defects. In these patients, needing complex hip revision surgery, the appreciation of the bony defect is crucial to assure stable fixation of the customised implant, often intended to replace a failed one. We aimed to understand the effect of metal artefact on the design of customised implants. METHODS 26 patients with massive acetabular defects were referred, between May 2016 and September 2018, to our institution classified as "un-reconstructable" by other hospitals. They all received custom 3D-printed acetabular cups. A subset of them underwent two-stage revision surgery due to infection. We then extended the two-stage procedure to the cases where metal artefacts were significantly affecting the reading of the CT scans. CT scans of patients' pelvises were taken pre and post-implant removal. We assessed for changes in bony shape and volume of the pelvis using 3D imaging software and quantified the effect on implant design with CAD software. RESULTS Eight (out of 26) patients (31%) underwent two-stage revision surgery. The CT bony reconstructions between the two timepoints changed in all cases. The changes were mostly associated to the shape and distribution of the acetabular defects. Three of these cases (37.5%) showed a remarkable difference in the remaining bone that led to a change in implant design. So far, there has been no difference in the clinical outcome between the patients who underwent single (n = 18) and two-stage surgery (n = 8). CONCLUSIONS The shape of the acetabulum reconstructed from CT data is potentially altered by metal artefact and bone excised during removal of the failed component. For "end-of-road" acetabular reconstruction, we recommend surgeons consider the use of two-stage surgery to enable a reliable fitting of the complex shape of 3D-printed implants.
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Affiliation(s)
- Anna Di Laura
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
| | - Robert Wescott
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Alister J. Hart
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP UK
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
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15
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Beckmann NA, Bitsch RG, Schonhoff M, Siebenrock KA, Schwarze M, Jaeger S. Comparison of the Primary Stability of Porous Tantalum and Titanium Acetabular Revision Constructs. MATERIALS 2020; 13:ma13071783. [PMID: 32290103 PMCID: PMC7179011 DOI: 10.3390/ma13071783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
Adequate primary stability of the acetabular revision construct is necessary for long-term implant survival. The difference in primary stability between tantalum and titanium components is unclear. Six composite hemipelvises with an acetabular defect were implanted with a tantalum augment and cup, using cement fixation between cup and augment. Relative motion was measured at cup/bone, cup/augment and bone/augment interfaces at three load levels; the results were compared to the relative motion measured at the same interfaces of a titanium cup/augment construct of identical dimensions, also implanted into composite bone. The implants showed little relative motion at all load levels between the augment and cup. At the bone/augment and bone/cup interfaces the titanium implants showed less relative motion than tantalum at 30% load (p < 0.001), but more relative motion at 50% (p = n.s.) and 100% (p < 0001) load. The load did not have a significant effect at the augment/cup interface (p = 0.086); it did have a significant effect on relative motion of both implant materials at bone/cup and bone/augment interfaces (p < 0.001). All interfaces of both constructs displayed relative motion that should permit osseointegration. Tantalum, however, may provide a greater degree of primary stability at higher loads than titanium. The clinical implication is yet to be seen
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Affiliation(s)
- Nicholas A. Beckmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany;
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
- Correspondence: or
| | - Rudi G. Bitsch
- National Joint Center, ATOS Clinics, 69115 Heidelberg, Germany;
| | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Klaus-Arno Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland;
| | - Martin Schwarze
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany;
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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Karvonen M, Laaksonen I, Pulkkinen P, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Manninen M, Mäkelä KT. Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register. J Arthroplasty 2020; 35:219-223. [PMID: 31526699 DOI: 10.1016/j.arth.2019.08.027] [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: 07/17/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data. METHODS A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group. RESULTS Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P = .8) to that of the reference group. CONCLUSION The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients.
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Affiliation(s)
- Mikko Karvonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Pulkkinen
- Department of Biostatistics, University of Helsinki, Helsinki, Finland
| | | | | | - Ari-Pekka Puhto
- Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | | | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
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Salem Eid A, Kotb A, Elshabrawy W. Cementless jumbo cups for revision of failed Furlong prosthesis. A case series. J Clin Orthop Trauma 2020; 11:56-61. [PMID: 32001985 PMCID: PMC6985161 DOI: 10.1016/j.jcot.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Revision of failed total hip arthroplasty (THA) presents great challenge to any orthopaedic surgeon especially in the presence of acetabular defects where the main goal is to achieve durable fixation of prosthetic components to bone which is the key to successful revision surgery. METHODS Seventeen patients (17 hips) with mean age of 52 (40-61) years had revision surgery for aseptic failure of Furlong hydroxyapatite-ceramic-coated (HAC) prosthesis using cementless jumbo cups. Patients were reviewed clinically and radiographically with mean follow-up of 3.5 years (2-6). No patient was lost to follow up. RESULTS All revised acetabular components showed polyethylene wear, severe metallosis, with acetabular defects IIB (4/17), and IIIA (13/17) according to Paprosky classification. The femoral component was well fixed in all cases but one patient had stem revision for femoral fracture mal-union. There was one early post-operative infection; there was no postoperative dislocation, sciatic nerve injury, periprosthetic fracture or deep venous thrombosis. At last follow-up, no progressive radiolucencies or acetabular migration was identified. The mean Harris hip score improved from 42 (24-59) pre-operatively to 85 (72-92). CONCLUSION Good clinical results and radiographic stability were obtained at short term follow up after acetabular revision using cementless jumbo cups, which justify its use in revision surgery even in the face of major acetabular defects. Furlong HAC femoral component gives excellent long-term survival in young and active patients with a survival rate of 94% at 18.6 years.
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18
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Hemmilä M, Karvonen M, Laaksonen I, Matilainen M, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Manninen M, Mäkelä KT. Survival of 11,390 Continuum cups in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register. Acta Orthop 2019; 90:312-317. [PMID: 30994043 PMCID: PMC6718180 DOI: 10.1080/17453674.2019.1603596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The use of trabecular metal (TM) cups for primary total hip arthroplasty (THA) is increasing. Some recent data suggest that the use of TM in primary THA might be associated with an increased risk of revision. We compared implant survival of Continuum acetabular cups with other commonly used uncemented cups. Patients and methods - Data on 11,390 primary THAs with the Continuum cup and 30,372 THAs with other uncemented cups (reference group) were collected from the Finnish Arthroplasty Register. Kaplan-Meier survival estimates were calculated; the endpoint was revision for any reason, for infection, or for dislocation. Revision risks were assessed with adjusted Cox multiple regression models. A subgroup analysis on the use of neutral or elevated liners in the Continuum group was made. Results - The 7-year survivorship of the Continuum group was 94.6% (95% CI 94.0-95.2) versus 95.6% (CI 95.3-95.8) in the reference group for revision for any reason. The risk for revision was higher in the Continuum group than in the reference group both for revision for any reason (HR 1.3 [CI 1.2-1.5)]) and for revision for dislocation (HR 1.9 [CI 1.5-2.3]). There was no difference in the rates of revision because of infection (HR 0.99 [CI 0.78-1.3]). Use of a neutral liner increased the risk for revision due to dislocation in comparison with the use of an elevated rim liner in the Continuum group (HR 1.7 [CI 1.2-2.5]). Interpretation - THA with Continuum cups is associated with an increased risk of revision compared with other uncemented cups, mainly due to revisions because of dislocation. Our results support the use of an elevated liner when Continuum cups are used for primary THA.
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Affiliation(s)
- Matias Hemmilä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku; ,Correspondence:
| | - Mikko Karvonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
| | | | | | | | - Ari-Pekka Puhto
- Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu;
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio;
| | | | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku;
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Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS. Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg 2019; 103:1-13. [PMID: 29654551 DOI: 10.1007/s12306-018-0539-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 04/08/2018] [Indexed: 12/29/2022]
Abstract
Acetabular revision especially in the presence of severe bone loss is challenging. There is a paucity of literature critiquing contemporary techniques of revision acetabular reconstruction and their outcomes. 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 shells, uncemented revision jumbo shells, reinforced cages and rings, oblong shells and custom-made triflange constructs). Full-text papers and those with an abstract in English published from January 2001 to January 2016 were identified through international databases. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. Overall, patients had improved outcomes irrespective of the technique of reconstruction as documented by postoperative hip scores. Our pooled analysis suggests 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 highest failure rates. However, this may reflect the complexity of revisions and severity of bone loss. The most common postoperative complication reported in all groups was dislocation. This review confirms successful acetabular reconstructions using diverse techniques depending on the type of bone loss and highlights key features and outcomes of different techniques. In particular, oblong cups and tantalum shells have successful survivorship.
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Affiliation(s)
- A Volpin
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - S Konan
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - C Biz
- Department of Trauma and Orthopaedics, University of Padova, Padua, Italy
| | - R J Tansey
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Chang CH, Hu CC, Chen CC, Mahajan J, Chang Y, Shih HN, Kwon YM. Revision Total Hip Arthroplasty for Paprosky Type III Acetabular Defect With Structural Allograft and Tantalum Trabecular Metal Acetabular Cup. Orthopedics 2018; 41:e861-e867. [PMID: 30371922 DOI: 10.3928/01477447-20181023-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
There are several surgical options for addressing Paprosky type III acetabular defects during revision total hip arthroplasty. In physiologically young and active patients, using structural bone graft to restore bone defects and provide adequate initial support for the revision acetabular component is one such option. This study reports the mid-term results of using a structural allograft accompanied by a trabecular metal-coated hemispherical cup for Paprosky type III defects. A retrospective analysis was performed of the data collected for 20 consecutive hips in 20 patients (mean age, 56.2 years; range, 43-68 years) with minimum 3-year follow-up (mean, 5.4 years; range, 3.3-10.3 years) who had a structural allograft accompanied by a trabecular metal-coated hemispherical cup for Paprosky type III defects. Only 1 hip had cup migration, which was less than 3 mm in vertical and less than 5° in inclination and recognized as loosening without symptoms. All grafts showed good incorporation with trabecular bridging over the graft and host bone. The mean modified Harris hip score showed significant improvement, from 29.7 (range, 11-52) preoperatively to 84.1 (range, 77-91) at the latest follow-up (P<.05). The use of a structural allograft combined with a tantalum trabecular metal acetabular cup in acetabular revision for Paprosky type III defects had a satisfactory mid-term clinical result. This is a viable option for patients with large acetabular shelf defects. [Orthopedics. 2018; 41(6):e861-e867.].
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21
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Laaksonen I, Lorimer M, Gromov K, Eskelinen A, Rolfson O, Graves SE, Malchau H, Mohaddes M. Trabecular metal acetabular components in primary total hip arthroplasty. Acta Orthop 2018; 89:259-264. [PMID: 29400118 PMCID: PMC6055786 DOI: 10.1080/17453674.2018.1431445] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/25/2017] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were included. The mean follow-up times were 3.0 years for the TM cups and 3.8 years for the other uncemented cups. Results - The overall survivorship up to 8 years for TM cups and other uncemented cups was 94.4% and 96.2%, respectively (p = < 0.001). Adjusting for relevant covariates in a Cox regression model the TM cups had a persistently higher revision risk than other uncemented cups (HR =1.5, 95% CI 1.4-1.7, p = < 0.001). There was a slightly higher, though not statistically significant, revision rate for PPI in the TM group (1.2, 95% CI 1.0-1.6, p = 0.09). Interpretation - Risk of revision for any reason was higher for the TM cup than for other uncemented cups in primary THA. In contrast to our hypothesis, there was no evidence that the revision rate for PPI was lower in the TM cup patients. Regardless of the promising early and mid-term results for TM cups in hip revision arthroplasty, we would like to sound a note of caution on the increasing use of the TM design, especially in uncomplicated primary THAs, where uncemented titanium cups are considered to provide a reliable outcome.
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Affiliation(s)
- Inari Laaksonen
- Harris Orthopedic Laboratory, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Danish Hip Arthroplasty Register, Aarhus, Denmark
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Finnish Arthroplasty Register, Helsinki, Finland
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Henrik Malchau
- Harris Orthopedic Laboratory, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
- Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
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López-Torres II, Sanz-Ruíz P, Sánchez-Pérez C, Andrade-Albarracín R, Vaquero J. Clinical and radiological outcomes of trabecular metal systems and antiprotrusion cages in acetabular revision surgery with severe defects: a comparative study. INTERNATIONAL ORTHOPAEDICS 2018; 42:1811-1818. [PMID: 29484473 DOI: 10.1007/s00264-018-3801-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS). METHODS Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years. RESULTS The BS group required a significantly greater number of constrained implants (p = 0.001) and more walking aids (p = 0.04). The mean satisfaction (p = 0.02) and HHS scores at the end of the follow-up were higher in the TM group (p = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years. CONCLUSION TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects.
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Affiliation(s)
- Irene Isabel López-Torres
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Pablo Sanz-Ruíz
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
- Universidad Complutense de Madrid, Av. Séneca 2, 28040, Madrid, Spain
| | - Coral Sánchez-Pérez
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Ricardo Andrade-Albarracín
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Javier Vaquero
- Department of Orthopaedic Surgery, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, 28007, Madrid, Spain
- Universidad Complutense de Madrid, Av. Séneca 2, 28040, Madrid, Spain
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Kukreja MM, Nishiyama SK, Kang PS. Management of radiation induced, bilateral Primary THA loosening with an aseptic Paprosky Type IIB acetabular defect and a contralateral septic Type IIIB acetabular defect: A case report and review of literature. Int J Surg Case Rep 2017; 42:218-223. [PMID: 29275237 PMCID: PMC5985256 DOI: 10.1016/j.ijscr.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Primary THA in an irradiated hip poses risk for early loosening and inadequate ingrowth.Adverse effects such as decreased vascularity and increased infection risk pose a threat. CASE PRESENTATION Our patient was a case of post-irradiation (for cervical cancer) bilateral THA loosening causing aseptic acetabular loosening on one side and catastrophic septic loosening with a Paprosky type IIIB acetabular defect with pelvic discontinuity on the contralateral side. DISCUSSION There have been various studies documenting deleterious effects of irradiation on osseointegration and provide a challenge for long-term implant stability in THA patients. CONCLUSION A meticulous treatment protocol with contemporary implant technology and staged bilateral stepwise management can lead to satisfactory clinical outcomes.This case report highlights on such specific nuances and principles.
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Affiliation(s)
- Mohit M Kukreja
- Desert Orthopaedic Center, 2800 E. Desert Inn, Suite 100, Las Vegas, NV 89121, United States.
| | - Steven K Nishiyama
- Orthopedic Surgery Residency Program, Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV 89106, United States.
| | - Parminder S Kang
- Joint replacement Section Chief at Touro University, Valley Hospital Medical Center and Desert Orthopaedic Center, 2800 E. Desert Inn, Suite 100, Las Vegas, Nevada 89121, United States.
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Kärrholm J. CORR Insights ®: Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty? Clin Orthop Relat Res 2017; 475:3023-3025. [PMID: 29027100 PMCID: PMC5670061 DOI: 10.1007/s11999-017-5472-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Johan Kärrholm
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, S-413 4, Gothenburg, Sweden
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Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty? Clin Orthop Relat Res 2017; 475. [PMID: 28646360 PMCID: PMC5670055 DOI: 10.1007/s11999-017-5417-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Earlier results with porous tantalum acetabular cups in revision THA generally have been favorable. Recently there has been some evidence presented that porous tantalum cups might decrease the risk of rerevision in the setting of revision hip surgery performed owing to prosthetic joint infection (PJI). As the data supporting this assertion come from a study with a limited study population, examining this issue with a large registry approach may be enlightening. QUESTIONS/PURPOSES By combining results from two large, national registries, we asked: (1) Do porous tantalum cups show improved survival after revision THA compared with other cementless designs? (2) Does the use of porous tantalum cups influence survivorship when rerevision for PJI is the endpoint? METHODS A total of 2442 first-time THA revisions with porous tantalum cups and 4401 first-time revisions with other uncemented cups were included in this collaborative study between the Australian and Swedish national joint registries. The mean age of the patients was 69 years (range, 19-97 years), 3754 (55%) of the patients were women, and the mean followup for the porous tantalum and uncemented control groups were 3.0 years (SD, ± 2.1 years) and 3.4 years (SD, ± 2.3 years), respectively. Concomitant stem revision was more common in the porous tantalum group (43% versus 36%). The use of porous tantalum augments also was analyzed as a proxy for more complex acetabular reconstructions. In an attempt to further reduce selection bias, we performed subgroup analysis for primary operations attributable to osteoarthritis and first revision attributable to aseptic loosening. RESULTS Kaplan-Meier survivorship with rerevisison for any reason up to 7 years was comparable between the porous tantalum cup group and the uncemented cup control group (86% [95% CI, 85%-89%] and 87% [95% CI, 85%-89%], respectively; p = 0.85) and the overall survivorship up to 7 years with a second revision for PJI as the endpoint (97% [95% CI, 95%-98%] and 97% [95% CI, 96%-98%], respectively; p = 0.64). Excluding procedures where augments had been used or studying primary osteoarthritis and first revision owing to aseptic loosening subgroups did not change this result. CONCLUSIONS Implant survival for a porous tantalum cup in first-time THA revision was similar to the survival of the uncemented cup control group. With the numbers available, no benefit in survival with rerevision for infection as the endpoint could be ascribed to the porous tantalum cup group, as has been suggested by earlier work. Further studies with acetabular bone deficiency data, greater insight into host comorbidity factors, and a longer followup are needed to corroborate or refute these results. LEVEL OF EVIDENCE Level III, therapeutic study.
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Evola FR, Costarella L, Evola G, Barchitta M, Agodi A, Sessa G. Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up. World J Orthop 2017; 8:553-560. [PMID: 28808626 PMCID: PMC5534404 DOI: 10.5312/wjo.v8.i7.553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions. METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method. RESULTS The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student's t test for paired samples: P < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student's t test for independent samples: P > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component. CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.
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Mahmoud AN, Sundberg M, Flivik G. Comparable Results With Porous Metal Augments in Combination With Either Cemented or Uncemented Cups in Revision Hip Arthroplasty: An Analysis of One Hundred Forty-Seven Revisions at a Mean of Five Years. J Arthroplasty 2017; 32:1612-1617. [PMID: 28062151 DOI: 10.1016/j.arth.2016.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/18/2016] [Accepted: 12/06/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. The purpose of this study was to retrospectively review and compare the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. METHODS Using our institutional clinical databases, the clinical and radiological outcomes of 104 cemented and 43 uncemented acetabular revisions with metal augments, performed between 2006 and 2015, were studied and compared. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. RESULTS At a mean follow-up of 60.1 months (range 12.7-112.1), a total of 5 cups (3.4%), being 3 cemented (2.8%) and 2 uncemented (4.6%), had shown signs of aseptic loosening with cup and augment migration and 4 of these have been re-revised (2.7%). At final follow-up, the European Quality of Life-5 Dimensions for generic health, and the Hip disability and Osteoarthritis Outcome Score (HOOS) parameters had improved substantially without any significant difference between fixation techniques. CONCLUSION Porous metal augments show comparable excellent radiographic and clinical mid-term outcomes when combined with cemented or uncemented cups in revision hip arthroplasty.
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Affiliation(s)
- Ahmed Nageeb Mahmoud
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Martin Sundberg
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Flivik
- Department of Orthopedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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Ranawat AS, Meftah M, Thomas AO, Thippanna RK, Ranawat CS. Use of Oversized Highly Porous Cups in Acetabular Revision. Orthopedics 2016; 39:e301-6. [PMID: 26913762 DOI: 10.3928/01477447-20160222-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/17/2015] [Indexed: 02/03/2023]
Abstract
This study assessed the efficacy of highly porous cups in revision total hip arthroplasty for Paprosky types II and III acetabular bone loss. The authors identified 33 acetabular revisions in 29 patients from a prospective database (66% type III, 7 with pelvic dissociation). Initial stability was achieved with interference fit between the anterior inferior iliac spine, pubis, and ischium with cups that were 2 to 4 mm larger than the reamed acetabulum and augmented with multiple screw fixations without allograft or wedges. At mean follow-up of 6 years (range, 2.7-7.7 years) after revision surgery, no dislocation, infection, or reoperation was noted. Mean satisfaction score was 6±3.2. Mean anteversion and abduction angles were 43°±4.6° and 21.5°±4.4°, respectively. Complications included limp in 13% of patients, wound issues in 10%, and heterotopic ossification in 17%. Osteointegration was seen in all cups, without any migration. Mean overall osteointegration, based on the average percentage of the 3 zones in both views, was 55%±21% (range, 25%-95%). The most osteointegration was seen in zone I (superior) and zone VI (posterior), and the least osseointegration was seen in zone II (medial) and zone IV (anterior). This method can provide reproducible results in acetabular revision arthroplasty.
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Use of porous tantalum components in Paprosky two and three acetabular revision. A minimum five-year follow-up of fifty one hips. INTERNATIONAL ORTHOPAEDICS 2016; 41:911-916. [PMID: 27766385 DOI: 10.1007/s00264-016-3312-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 10/03/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components. OBJECTIVES The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up. METHODS We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface. RESULTS At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months. CONCLUSIONS When facing an acetabular revision with severe bone loss, tantalum-made components can provide a stable fixation. This study at a minimum five-year follow-up compares favourably with other reconstruction techniques, but longer follow-up is still required.
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Trabecular TitaniumTM cups and augments in revision total hip arthroplasty: clinical results, radiology and survival outcomes. Hip Int 2016; 26:486-491. [PMID: 27229161 DOI: 10.5301/hipint.5000378] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Large acetabular defects remain a challenge in hip revision arthroplasty. Experience with Trabecular Titanium™ (TT) cups (Limacorporate S.p.a.) has not been widely reported. Therefore, we assessed the survivorship and clinical and radiological outcomes of patients receiving TT cups, with or without supplementary trabecular titanium hemispherical modules for acetabular reconstruction, in primary and revision total hip arthroplasty (THA). METHODS Between January 2009 and July 2014, we performed 67 revisions and 5 primary THAs using TT cups in 69 patients. To achieve stability and/or restore the hip's centre of rotation, hemispherical modules were used in 17 cases based on preoperative templating and/or intraoperative findings. Mean follow-up was 30.5 months. Acetabular bone defects were classified according to the Paprosky classification. Survivorship, functional outcomes (Merle d'Aubigné) and radiological outcomes were analysed. RESULTS 8 patients underwent cup revision: 2 for loosening, 3 for infection, and 3 for hip dislocation. The remaining cases did not present radiological signs of loosening. None of the cases with Paprosky type I classifications needed revision, while 4 with type II and 4 with type III needed revision (p = 0.028). The respective mean values for pain, walking, and range of motion (Merle d'Aubigné scores ± standard deviation) were 3.6 ± 1.4, 3.7 ± 0.7, and 3.8 ± 0.6 preoperatively, and 5.7 ± 0.7, 5.3 ± 0.7, and 5.6 ± 0.7 at the latest follow-up (p<0.001). CONCLUSIONS In the short term, results with TT cups appear to be encouraging, with satisfactory survival rates for both simple and complex cases.
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31
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Custom 3D-printed acetabular implants in hip surgery--innovative breakthrough or expensive bespoke upgrade? Hip Int 2016; 25:375-9. [PMID: 26351112 DOI: 10.5301/hipint.5000294] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 02/04/2023]
Abstract
Custom 3D-printed triflange acetabular cages are a new option in the armamentarium of the revision hip surgeon. This review article defines this technology, its indications, surgical method, advantages, disadvantages, use, current published literature and future applications.
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32
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Konan S, Duncan CP, Masri BA, Garbuz DS. Porous tantalum uncemented acetabular components in revision total hip arthroplasty. Bone Joint J 2016; 98-B:767-71. [PMID: 27235518 DOI: 10.1302/0301-620x.98b6.37183] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/12/2016] [Indexed: 11/05/2022]
Abstract
Aims Reconstruction of the acetabulum after failed total hip arthroplasty (THA) can be a surgical challenge in the presence of severe bone loss. We report the long-term survival of a porous tantalum revision acetabular component, its radiological appearance and quality of life outcomes. Patients and Methods We reviewed the results of 46 patients who had undergone revision of a failed acetabular component with a Paprosky II or III bone defect and reconstruction with a hemispherical, tantalum acetabular component, supplementary screws and a cemented polyethylene liner. Results After a minimum follow-up of ten years (ten to 12), the survivorship of the porous tantalum acetabular component was 96%, with further revision of the acetabular component as the end point. The ten-year survivorship, with hip revision for any reason as the end point, was 92%. We noted excellent pain relief (mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) score pain 92.6, (40 to 100)) and good functional outcomes (mean WOMAC function 90.3 (30.9 to 100), mean University of California Los Angeles activity scale 5 (2 to 10)) and generic quality of life measures (mean Short Form-12 (SF-12) physical component 48.3 (18.1 to 56.8), mean SF-12 mental component 56.7 (32.9 to 70.3)). Patient satisfaction with pain relief, function and return to recreational activities were excellent. Take home message: Uncemented acetabular reconstruction using a tantalum acetabular component gives excellent clinical and quality of life outcomes at a minimum follow-up of ten years. Cite this article: Bone Joint J 2016;98-B:767–71.
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Affiliation(s)
- S. Konan
- University of British Columbia, JP
North 3rd floor, Room 3114, 910 West
10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - C. P. Duncan
- University of British Columbia, JP
North 3rd floor, Room 3114, 910 West
10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - B. A. Masri
- University of British Columbia, JP
North 3rd floor, Room 3114, 910 West
10th Avenue, Vancouver, BC
V5Z 4E3, Canada
| | - D. S. Garbuz
- University of British Columbia, JP
North 3rd floor, Room 3114, 910 West
10th Avenue, Vancouver, BC
V5Z 4E3, Canada
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Clement RGE, Ray AG, MacDonald DJ, Wade FA, Burnett R, Moran M. Trabecular Metal Use in Paprosky Type 2 and 3 Acetabular Defects: 5-Year Follow-Up. J Arthroplasty 2016; 31:863-7. [PMID: 26711861 DOI: 10.1016/j.arth.2015.10.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/12/2015] [Accepted: 10/23/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reconstructive challenge of achieving a stable acetabulum in revision total hip arthroplasties in the presence of major osteolytic lesions has led to debate about the most appropriate surgical strategy to minimize implant-related failures. Trabecular metal (TM) implants have become popular but ongoing surveillance of their performance is required. METHODS We reviewed the clinical and radiological outcome of a consecutive series of 52 patients (55 hips) who had undergone revision total hip arthroplasty for Paprosky type 2 or 3 acetabular defects with TM revision acetabular shells between 2002 and 2008. RESULTS Four implant failures occurred (2 infections and 2 dislocations). Eleven patients from this cohort died (representing 12 hips) before the 5-year follow-up period giving us a follow-up of 78.2%. Implant survival at 5 years was 92% (95% confidence interval: 80.2%-96.9%). There were no cases of radiological loosening. The mean Oxford hip score was 34 (range, 5-48) at a mean follow-up of 63 months (range, 34-105 months). CONCLUSIONS We conclude that the use of TM revision shells for complex acetabular reconstruction yields satisfactory results.
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Affiliation(s)
- Rhys G E Clement
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew G Ray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Deborah J MacDonald
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Frazer A Wade
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Richard Burnett
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Moran
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Chiu FY, Lin YP, Hung SH, Su YP, Liu CL. Cementless Acetabular Reconstruction for Arthropathy in Old Acetabular Fractures. Orthopedics 2015; 38:e934-9. [PMID: 26488791 DOI: 10.3928/01477447-20151002-63] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/16/2015] [Indexed: 02/03/2023]
Abstract
This study was conducted to identify the factors influencing mechanical failure of cementless acetabular reconstruction for arthropathy after operative treatment of acetabular fractures. Fifty-six patients (56 hips) undergoing cementless total hip arthroplasty were enrolled and followed for a mean of 120 months (range, 60-180 months). The 10-year survival rate, with mechanical failure (radiographic loosening or revision due to aseptic loosening) as the endpoint, was analyzed with respect to sex, age, body mass index (BMI), acetabular bone deficiency, sclerotic changes to the acetabulum, and use of the Trabecular Metal (TM) cup (Zimmer, Inc, Warsaw, Indiana). Mean 10-year survival rates of the acetabular component were as follows: 80% (range, 65%-96%) in males and 100% in females (P=.032); 77% (range, 60%-95%) in patients younger than 50 years and 91% (range, 82%-100%) in older patients (P=.027); 88% (range, 78%-98%) in patients with a BMI less than 30 kg/m(2) and 81% (range, 74%-89%) in patients with a BMI of 30 kg/m(2) or higher (P=.068); 54% (range, 32%-76%) in patients manifesting large acetabular deficiency and 90% (range, 78%-100%) in the remaining patients (P<.001); 78% (range, 65%-91%) in patients with the presence of sclerotic acetabulum and 92% (range, 86%-100%) in patients with the absence of sclerotic acetabulum (P=.022); and 82% (range, 73%-100%) in patients who received a conventional shell and 100% in patients who received the TM cup (P=.039). Male sex, age younger than 50 years, large acetabular deficiency, and sclerotic changes of the acetabulum were significant factors contributing to the mechanical failure of cementless acetabular reconstruction performed for old acetabular fractures treated with open reduction and internal fixation. Use of the TM cup seemed able to prolong the endurance of the acetabular component in the subsequent reconstruction.
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Daivajna S, Duncan C, Masri B, Garbuz D. Highly porous metal shells and augments in revision hip surgery: Big hopes for big holes. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.sart.2015.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Teeter MG, Naudie DDR, Howard JL, McCalden RW, MacDonald SJ. Do revision total hip augments provide appropriate modularity? Can J Surg 2015; 58:54-7. [PMID: 25621911 DOI: 10.1503/cjs.005514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Porous metal acetabular augments have become widely used to fill bony defects in patients undergoing revision total hip arthroplasty. The objective of this study was to determine whether the currently offered size range of the augments is appropriate for surgical needs. METHODS We reviewed the cases of all patients at 1 centre with a porous revision shell, and when an augment was used we recorded the patient and implant characteristics. RESULTS We reviewed the cases of 281 patients, and augments were used in 24. Augment diameter was skewed toward the small end (p < 0.001), although thickness was not (p = 0.05); 21 of 24 augments were those with the smallest 3 diameters and thicknesses. CONCLUSION Given the sizes used, the full range of inventory provided by the manufacturer may be unnecessary, as surgeons will likely attempt a larger shell before a larger augment.
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Affiliation(s)
- Matthew G Teeter
- The Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont
| | - Douglas D R Naudie
- The Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont
| | - James L Howard
- The Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont
| | - Richard W McCalden
- The Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont
| | - Steven J MacDonald
- The Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont
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von Roth P, Abdel MP, Wauer F, Winkler T, Wassilew G, Diederichs G, Perka C. Significant muscle damage after multiple revision total hip replacements through the direct lateral approach. Bone Joint J 2015; 96-B:1618-22. [PMID: 25452363 DOI: 10.1302/0301-620x.96b12.34256] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intact abductors of the hip play a crucial role in preventing limping and are known to be damaged through the direct lateral approach. The extent of trauma to the abductors after revision total hip replacement (THR) is unknown. The aim of this prospective study was to compare the pre- and post-operative status of the gluteus medius muscle after revision THR. We prospectively compared changes in the muscle and limping in 30 patients who were awaiting aseptic revision THR and 15 patients undergoing primary THR. The direct lateral approach as described by Hardinge was used for all patients. MRI scans of the gluteus medius and functional analyses were recorded pre-operatively and six months post-operatively. The overall mean fatty degeneration of the gluteus medius increased from 35.8% (1.1 to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision THRs (p = 0.03). There was a similar pattern after primary THR, but with considerably less muscle damage (p = 0.001), indicating progressive muscle damage. Despite an increased incidence of a positive Trendelenburg sign following revision surgery (p = 0.03) there was no relationship between the cumulative fatty degeneration in the gluteus medius and a positive Trendelenburg sign (p = 0.26). The changes associated with other surgical approaches to the hip warrant investigation.
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Affiliation(s)
- P von Roth
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - M P Abdel
- Mayo Clinic, Department of Orthopedic Surgery, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - F Wauer
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - T Winkler
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - G Wassilew
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - G Diederichs
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - C Perka
- Charité Universitaetsmedizin , Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, Charitéplatz 1, 10117 Berlin, Germany
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Mohaddes M, Rolfson O, Kärrholm J. Short-term survival of the trabecular metal cup is similar to that of standard cups used in acetabular revision surgery. Acta Orthop 2015; 86:26-31. [PMID: 25399966 PMCID: PMC4366676 DOI: 10.3109/17453674.2014.984114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The use of trabecular metal (TM) cups in revision surgery has increased worldwide during the last decade. Since the introduction of the TM cup in Sweden in 2006, this design has gradually replaced other uncemented designs used in Sweden. According to data from the Swedish Hip Arthroplasty Register (SHAR) in 2012, one-third of all uncemented first-time cup revisions were performed using a TM cup. We compared the risk of reoperation and re-revision for TM cups and the 2 other most frequently used cup designs in acetabular revisions reported to the SHAR. The hypothesis was that the performance of TM cups is as good as that of established designs in the short term. PATIENTS AND METHODS The study population consisted of 2,384 patients who underwent 2,460 revisions during the period 2006 through 2012. The most commonly used cup designs were the press-fit porous-coated cup (n = 870), the trabecular metal cup (n = 805), and the cemented all-polyethylene cup (n = 785). 54% of the patients were female, and the median age at index revision was 72 (19-95) years. Reoperation was defined as a second surgical intervention, and re-revision-meaning exchange or removal of the cup-was used as endpoint. The mean follow-up time was 3.3 (0-7) years. RESULTS There were 215 reoperations, 132 of which were re-revisions. The unadjusted and adjusted risk of reoperation or re-revision was not significantly different for the TM cup and the other 2 cup designs. INTERPRETATION Our data support continued use of TM cups in acetabular revisions. Further follow-up is necessary to determine whether trabecular metal cups can reduce the re-revision rate in the long term, compared to the less costly porous press-fit and cemented designs.
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Affiliation(s)
- Maziar Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; the Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
| | - Ola Rolfson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; the Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
| | - Johan Kärrholm
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; the Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
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Berasi CC, Berend KR, Adams JB, Ruh EL, Lombardi AV. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res 2015; 473:528-35. [PMID: 25315276 PMCID: PMC4294939 DOI: 10.1007/s11999-014-3969-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon's ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components. QUESTIONS/PURPOSES The purposes of this study were to determine the (1) frequency of repeat revision, (2) complications and radiographic findings, and (3) Harris hip scores in patients who underwent complex acetabular revision surgery with custom acetabular components. METHODS Between August 2003 and February 2012, 26 patients (28 hips) have undergone acetabular reconstruction with custom triflange components. During this time, the general indications for using these implants included (1) failed prior salvage reconstruction with cage or porous metal construct augments, (2) large contained defects with possible discontinuity, (3) known pelvic discontinuity, and (4) complex multiply surgically treated hips with insufficient bone stock to reconstruct using other means. This approach was used in a cohort of patients with Paprosky Type 3B acetabular defects, which represented 3% (30 of 955) of the acetabular revisions we performed during the study period. Minimum followup was 2 years (mean, 57 months; range, 28-108 months). Seven patients (eight hips) died during the study period, and three (11%) of these patients (four hips; 14%) were lost to followup before 2 years, leaving 23 patients (24 hips) with minimum 2-year followup. Sixteen patients were women. The mean age of the patients was 67 years (range, 47-85 years) and mean BMI was 28 kg/m2 (range, 23-39 kg/m2). Revisions and complications were identified by chart review; hip scores were registered in our institution's longitudinal database. Pre- and postoperative radiographs were analyzed by the patient's surgeon to determine whether migration, fracture of fixation screws, or continued bone loss had occurred. RESULTS There have been four subsequent surgical interventions: two failures secondary to sepsis, and one stem revision and one open reduction internal fixation for periprosthetic femoral fracture. There were two minor complications managed nonoperatively, but all of the components were noted to be well-fixed with no obvious migration or loosening observed on the most recent radiographs. Harris hip scores improved from a mean of 42 (SD, ±16) before surgery to 65 (SD, ±18) at latest followup (p<0.001). CONCLUSIONS Custom acetabular triflange components represent yet another tool in the reconstructive surgeon's armamentarium. These devices can be helpful in situations of catastrophic bone loss. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
| | - Keith R. Berend
- />Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
- />The Ohio State University Wexner Medical Center, Columbus, OH USA
- />Mount Carmel Health System, New Albany, OH USA
| | - Joanne B. Adams
- />Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
| | - Erin L. Ruh
- />Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
| | - Adolph V. Lombardi
- />Joint Implant Surgeons, Inc, 7277 Smith’s Mill Road, Suite 200, New Albany, OH 43054 USA
- />The Ohio State University Wexner Medical Center, Columbus, OH USA
- />Mount Carmel Health System, New Albany, OH USA
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Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review. Hip Int 2014; 24:109-22. [PMID: 24186672 DOI: 10.5301/hipint.5000101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 02/04/2023]
Abstract
Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal (TM) systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection.
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Steno B, Kokavec M, Necas L. Acetabular revision arthroplasty using trabecular titanium implants. INTERNATIONAL ORTHOPAEDICS 2014; 39:389-95. [PMID: 25192688 DOI: 10.1007/s00264-014-2509-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/12/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate early results of acetabular revisions of total hip replacement using fully cementless trabecular titanium (TT) acetabular modular implants (Delta Trabecular Titanium, Limacorporate, Udine, Italy). METHODS Between March 2009 and May 2012 TT was used in 81 revisions. The mean age at the time of revision was 68 years (32-84 years). There were nine patients revised for type 1, 11 for type 2A, 27 for type 2B, six for type 2C, 15 for type 3A and 13 for type 3B acetabular defects according to the Paprosky classification. Frozen morselised bone allografts were used in 53 cases and bulk structural allografts in three cases. Clinical evaluations were made using a modified functional Merle d'Aubigné-Postel score. The mean follow-up period was 38.14 months (24-62 months). RESULTS The mean pre-operative Merle d'Aubigné-Postel functional score was 4.7 and 9.8 at the time of last follow-up. There was one revision due to instability of the acetabular component. A cage system-Delta Revision TT-was successfully used in this case. Three cases with Paprosky type 3B defect showed cranial migration of the acetabular component by 6 mm, but stabilised after six months. No dislocations associated with acetabular surgery have occurred in the cohort. There have been no dissociations of the modular component. A fatigue fracture of the hemispherical module occurred in the revised case. No other hardware mechanical failures have been recorded. CONCLUSIONS TT cups, hemispherical modules and augments facilitate reliable and reproducible biological fixation in acetabular revision surgery with excellent results. Extended follow-up is necessary to evaluate the long-term performance of TT modular implants.
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Affiliation(s)
- Boris Steno
- University Department of Orthopaedic and Trauma Surgery, Bratislava University Hospital, II, Bratislava, Slovakia,
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Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects. J Arthroplasty 2014; 29:1318-22. [PMID: 24405625 DOI: 10.1016/j.arth.2013.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/26/2013] [Accepted: 12/04/2013] [Indexed: 02/01/2023] Open
Abstract
Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27-4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3-29 months). At a mean follow-up of 37 ± 14 months (range, 24-66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.
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Modulare Defektrekonstruktion beim Pfannenwechsel mit Abstützschale und metallischen Augmenten. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2014; 26:141-55. [DOI: 10.1007/s00064-013-0271-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 10/25/2022]
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Wegrzyn J, Pibarot V, Jacquel A, Carret JP, Béjui-Hugues J, Guyen O. Acetabular reconstruction using a Kerboull cross-plate, structural allograft and cemented dual-mobility cup in revision THA at a minimum 5-year follow-up. J Arthroplasty 2014; 29:432-7. [PMID: 23849510 DOI: 10.1016/j.arth.2013.05.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/11/2013] [Accepted: 05/28/2013] [Indexed: 02/01/2023] Open
Abstract
The current study aimed to evaluate the outcome of a continuous and prospective series of 61 revision THAs with AAOS grade III and IV acetabular bone defect reconstruction using a Kerboull cross-plate, structural allograft and cemented dual mobility cup (Saturne, Amplitude, Valence, France). At a 7.5-year mean follow-up, no instability was reported after revision. In addition, no failure of the acetabular reconstruction was observed in 98% of the patients with complete allograft osseointegration and no evidence of mechanical rupture of the Kerboull cross-plate and/or loosening of the cemented dual mobility cup. In conclusion, such reconstruction technique demonstrated excellent results at mid-term follow-up in terms of prevention of instability after revision, restoration of the acetabular bone stock, and stable cemented fixation of the dual mobility cup.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Alexandre Jacquel
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Paul Carret
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jacques Béjui-Hugues
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Olivier Guyen
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France; LBMC_UMR T 9406 IFSTTAR/Université de Lyon, Lyon, France
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Beckmann NA, Weiss S, Klotz MCM, Gondan M, Jaeger S, Bitsch RG. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 2014; 29:229-35. [PMID: 23719095 DOI: 10.1016/j.arth.2013.04.035] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 03/01/2013] [Accepted: 04/17/2013] [Indexed: 02/01/2023] Open
Abstract
The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years) to determine if a difference with regard to revision failure could be determined. Failure rates of the respective implants were compared statistically using a logistic regression model with adjustment for discrepancies in FU time. In our study, TM shows statistically significant decreased loosening rates relative to revision rings for all grades including severe acetabular defects and pelvic discontinuity. The severe defects appear to benefit the most from TM.
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Affiliation(s)
- Nicholas A Beckmann
- Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg, Germany
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Salvaged failed roof rings and antiprotrusion cages: surgical options and implant survival. Hip Int 2013; 23:166-72. [PMID: 23475421 DOI: 10.5301/hipint.5000009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Failed acetabular reinforcement rings (ARR) (roof rings and antiprotrusion cages) may require another ARR reconstruction or another type of acetabular device with or without a bone graft. The purpose of this study was to propose surgical options for salvage of failed ARRs and to compare the failure rate of each surgical option.
MATERIALS AND METHODS We reviewed 33 first ARRs (12 roof rings and 21 antiprotrusion cages) which were revised and converted to a new acetabular reconstruction. Operative reports, radiographs,
and clinical data were evaluated. Minimum follow-up was 24 months (average 57 months; range 24-209 months).
RESULTS 33 failed first ARRs were converted to one of three types of acetabular reconstruction, Trabecular Metal (TM) cup in 14, cup-cage in 7 and a second ARR in 12. The TM cup group (TM cup and cup-cage) had a significantly longer survival than the second ARR group (P = 0.025) on log-rank analysis.
DISCUSSION Treatment of a failed first ARR by a TM cup and a cup-cage provides better results when compared to treatment by a second ARR. Restoration of bone stock is the main factor in determining whether a TM cup or cup-cage rather than another conventional ARR can be used.
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Porous tantalum shells and augments for acetabular cup revisions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:911-7. [DOI: 10.1007/s00590-013-1354-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/30/2013] [Indexed: 01/05/2023]
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Issack PS. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 2013; 95:1981-7. [PMID: 24196469 DOI: 10.2106/jbjs.l.01313] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
➤ Over the past decade, porous tantalum has emerged as a powerful tool for reconstruction of the failed acetabular component.➤ The increased porosity, high coefficient of friction, and favorable elastic modulus of porous tantalum compared with traditional titanium mesh or cobalt chromium acetabular components allow for greater bone ingrowth potential, implant stability, and host bone preservation, respectively, in porous tantalum shells.➤ Several studies have confirmed the excellent early and midterm results of porous tantalum reconstruction for revision hip arthroplasty.➤ Depending on the degree of bone loss, excellent results have been achieved with modular or revision porous tantalum shells, tantalum shells with tantalum augments, and cup-cage constructs.➤ These implants and techniques are greatly changing the approach to acetabular revision surgery and are providing constructs with greater stability and more physiologic biomechanical properties than those achieved through the use of traditional reconstructive methods.
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Affiliation(s)
- Paul S Issack
- Department of Orthopaedic Surgery, New York Downtown Hospital, 170 William Street, 8th Floor, New York, NY 10038. E-mail address:
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Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Systematic review on outcomes of acetabular revisions with highly-porous metals. INTERNATIONAL ORTHOPAEDICS 2013; 38:689-702. [PMID: 24178061 DOI: 10.1007/s00264-013-2145-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. METHOD A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. RESULTS The mean aseptic survivorship was 97.2% (range, 80-100%). The Harris hip scores improved from a mean pre-operative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of peri-acetabular radiolucencies was 2.4% (range, 0-8.8%) and 4.6% (range, 0-19%), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. CONCLUSION The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.
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Affiliation(s)
- Samik Banerjee
- Department of Orthopaedic Surgery, Rubin Institute for Advanced Orthopaedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
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Schmitz HCR, Klauser W, Citak M, Al-Khateeb H, Gehrke T, Kendoff D. Three-year follow up utilizing tantal cones in revision total knee arthroplasty. J Arthroplasty 2013; 28:1556-60. [PMID: 23664075 DOI: 10.1016/j.arth.2013.01.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/04/2013] [Accepted: 01/25/2013] [Indexed: 02/01/2023] Open
Abstract
There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37 months (32-48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6-90) to 63 points (range, 7-90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery.
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