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Nimmal Haribabu G, Basu B. Implementing Machine Learning approaches for accelerated prediction of bone strain in acetabulum of a hip joint. J Mech Behav Biomed Mater 2024; 153:106495. [PMID: 38460455 DOI: 10.1016/j.jmbbm.2024.106495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
The Finite Element (FE) methods for biomechanical analysis involving implant design and subject parameters for musculoskeletal applications are extensively reported in literature. Such an approach is manually intensive and computationally expensive with longer simulations times. Although Artificial Intelligence (AI) based approaches are implemented to a limited extent in biomechanics, such approaches to predict bone strain in acetabulum of a hip joint, are hardly explored. In this context, the primary objective of this paper is to evaluate machine learning (ML) models in tandem with high-fidelity FEA data for the accelerated prediction of the biomechanical response in the acetabulum of the human hip joint, during the walking gait. The parameters used in the FEA study included the subject weight, number and distribution of fins on the periphery of the acetabular shell, bone condition and phases of the gait cycle. The biomechanical response has also been evaluated using three different acetabular liners, including pre-clinically validated HDPE-20% HA-20% Al2O3, highly-crosslinked ultrahigh molecular weight polyethylene (HC-UHMWPE) and ZrO2-toughened Al2O3 (ZTA). Such parametric variation in FEA analysis, involving 26 variables and a full factorial design resulted in 10,752 datasets for spatially varying bone strains. The bone condition, as opposed to subject weight, was found to play a statistically significant role in determining the strain response in the periprosthetic bone of the acetabulum. While utilising hyperparameter tuning, K-fold cross validation and statistical learning approaches, a number of ML models were trained on the FEA dataset, and the Random Forest model performed the best with a coefficient of determination (R2) value of 0.99/0.97 and Root Mean Square Error (RMSE) of 0.02/0.01 on the training/test dataset. Taken together, this study establishes the potential of ML approach as a fast surrogate of FEA for implant biomechanics analysis, in less than a minute.
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Affiliation(s)
- Gowtham Nimmal Haribabu
- Laboratory for Biomaterials Science and Translational Research, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India
| | - Bikramjit Basu
- Laboratory for Biomaterials Science and Translational Research, Materials Research Centre, Indian Institute of Science, Bangalore, 560012, India.
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Moussa A, Rahman S, Xu M, Tanzer M, Pasini D. Topology optimization of 3D-printed structurally porous cage for acetabular reinforcement in total hip arthroplasty. J Mech Behav Biomed Mater 2020; 105:103705. [PMID: 32279849 DOI: 10.1016/j.jmbbm.2020.103705] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023]
Abstract
Aseptic loosening and mechanical failure of acetabular reinforcement components are among the main causes of their reduced service life. Current acetabular implants typically feature a structural solid layer that provides load bearing capacity, coated with a foam of uniform porosity to reduce stress shielding and implant loosening. This paper presents an alternative concept for a 3D printed cage that consists of a multifunctional fully porous layer with graded attributes that integrate both structural function and bone in-growth properties. The design comprises a hemispherical cup affixed to a superior flange with architecture featuring an optimally graded porosity. The methodology here presented combines an upscaling mechanics scheme of lattice materials with density-based topology optimization, and includes additive manufacturing constraints and bone ingrowth requirements in the problem formulation. The numerical results indicate a 21.4% reduction in the maximum contact stress on the bone surface, and a 26% decrease in the bone-implant interface peak micromotion, values that are indicative of enhanced bone ingrowth and implant long-term stability.
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Affiliation(s)
- Ahmed Moussa
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Shakurur Rahman
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Manman Xu
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada
| | - Michael Tanzer
- Division of Orthopaedics, Department of Surgery, McGill University, Jo Miller Orthopaedic Research Laboratory, Montreal, Quebec, H3G1A4, Canada
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, H3A0C3, Canada.
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Baba T, Homma Y, Jinnai Y, Tanabe H, Banno S, Watari T, Kaneko K. Posterior versus direct anterior approach in revision hip arthroplasty using Kerboull-type plate. SICOT J 2020; 6:2. [PMID: 31934846 PMCID: PMC6959137 DOI: 10.1051/sicotj/2019040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/11/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: The purpose of this study was to investigate revision with a Kerboull-type plate through the posterior approach (PA) and direct anterior approach (DAA) and compare the clinical outcome. Subjects and methods: Fifty-four patients (56 hip joints) underwent revision surgery in which acetabular reconstruction was performed concomitantly using the Kerboull-type plate and allogeneic bone. Revision surgery through DAA was performed in 21 hip joints and these were compared with 34 hip joints treated through PA. There was no significant difference in the patient demographics between the DAA and PA. Results: There was no significant difference between the operative times in the DAA and PA groups (203.2 ± 43.5 and 211.7 ± 41.8 min). There was a significant difference between the intraoperative blood loss in the DAA and PA groups (503.9 ± 223.7 mL and 703.8 ± 329.6 mL, respectively, p < 0.05). There was no significant difference between the modified Harris Hip Score in the DAA and the PA groups. The loosening of the acetabular component was observed in four cases (11.8%) in the PA group. In the DAA and PA groups, the 5-year survival rates were 100 and 85.7%, respectively. Recurrent dislocation of the hip was observed in six cases (one case in the DAA group (4.8%) and five cases in the PA group (14.7%)). Conclusions: It was verified that the difference in the surgical approach of acetabular reconstruction concomitantly using the Kerboull-type plate and allogeneic bone graft influenced the postoperative outcome.
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Affiliation(s)
- Tomonori Baba
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuta Jinnai
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sammy Banno
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Taiji Watari
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan
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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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Triflange acetabular reconstruction for pelvic discontinuity through a direct anterior approach. Arthroplast Today 2019; 5:407-412. [PMID: 31886380 PMCID: PMC6920714 DOI: 10.1016/j.artd.2019.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
A 74-year-old female patient presented to our clinic with pelvic discontinuity after multiple revision total hip surgeries requiring custom triflange acetabular reconstruction, which we accomplished through a direct anterior approach to the hip. The direct anterior approach to the hip has grown in popularity but still has the reputation of being a minimally invasive approach without the capacity for extensile exposure in the revision setting. We describe the extensile technique and demonstrate through our case the ability to perform the most challenging cases through this approach and discuss the potential benefits of its utilization.
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Tamaki T, Ninomiya T, Jonishi K, Miura Y, Oinuma K, Shiratsuchi H. Acetabular revision using a Kerboull-type reinforcement device through direct anterior approach. J Orthop Surg (Hong Kong) 2019; 26:2309499018782553. [PMID: 29945476 DOI: 10.1177/2309499018782553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The direct anterior approach has gained popularity in total hip arthroplasty (THA) over the past decade. However, there are few reports that describe the use of this approach for cases of complex revision. The purpose of this study was to report the surgical procedure and early clinical results of acetabular revision in the presence of bone defects using a Kerboull-type reinforcement device through the direct anterior approach. METHODS Eleven patients who had undergone acetabular reconstruction using a Kerboull-type reinforcement device for aseptic or septic loosening bone defects were enrolled. All procedures were performed using the direct anterior approach on a standard operating table. The mean age was 71.8 years, the mean period from initial surgery to revision THA was 14.5 years, and the mean follow-up period was 19.8 months. RESULTS The Kerboull-type acetabular reinforcement device with cemented cup combined with allogenic femoral head bone grafts was used in all hips. The mean operative time and intraoperative blood loss were 148 min and 743 g, respectively. None of the patients required allogeneic blood transfusion. One patient required revision surgery 11 months postoperatively because of device displacement. No other major or minor orthopedic complications were observed. CONCLUSION The direct anterior approach allows for less invasive acetabular reconstruction using a Kerboull-type reinforcement device.
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Affiliation(s)
- Tatsuya Tamaki
- Joint Reconstruction Center, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Taishi Ninomiya
- Joint Reconstruction Center, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Kurato Jonishi
- Joint Reconstruction Center, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Yoko Miura
- Joint Reconstruction Center, Funabashi Orthopedic Hospital, Chiba, Japan
| | - Kazuhiro Oinuma
- Joint Reconstruction Center, Funabashi Orthopedic Hospital, Chiba, Japan
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Chatterjee S, Kobylinski S, Basu B. Finite Element Analysis to Probe the Influence of Acetabular Shell Design, Liner Material, and Subject Parameters on Biomechanical Response in Periprosthetic Bone. J Biomech Eng 2019; 140:2681672. [PMID: 30029239 DOI: 10.1115/1.4040249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/08/2022]
Abstract
The implant stability and biomechanical response of periprosthetic bone in acetabulum around total hip joint replacement (THR) devices depend on a host of parameters, including design of articulating materials, gait cycle and subject parameters. In this study, the impact of shell design (conventional, finned, spiked, and combined design) and liner material on the biomechanical response of periprosthetic bone has been analyzed using finite element (FE) method. Two different liner materials: high density polyethylene-20% hydroxyapatite-20% alumina (HDPE-20%HA-20%Al2O3) and highly cross-linked ultrahigh molecular weight polyethylene (HC-UHMWPE) were used. The subject parameters included bone condition and bodyweight. Physiologically relevant load cases of a gait cycle were considered. The deviation of mechanical condition of the periprosthetic bone due to implantation was least for the finned shell design. No significant deviation was observed at the bone region adjacent to the spikes and the fins. This study recommends the use of the finned design, particularly for weaker bone conditions. For stronger bones, the combined design may also be recommended for higher stability. The use of HC-UHMWPE liner was found to be better for convensional shell design. However, similar biomechanical response was captured in our FE analysis for both the liner materials in case of other shell designs. Overall, the study establishes the biomechanical response of periprosthetic bone in the acetabular with preclinically tested liner materials together with new shell design for different subject conditions.
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Affiliation(s)
- Subhomoy Chatterjee
- Materials Research Centre, Indian Institute of Science, Bengaluru 560012, Karnataka, India; Translational Center on Biomaterials for Orthopaedic and Dental Applications, Indian Institute of Science, Bengaluru 560012, Karnataka, India
| | - Sabine Kobylinski
- Materials Research Centre, Indian Institute of Science, Bengaluru 560012, Karnataka, India; Centre for BioSystems and Engineering, Indian Institute of Science, Bengaluru 560012, Karnataka, India; Technical University of Applied Sciences Regensburg (OTH Regensburg), Regensburg 93047, Germany
| | - Bikramjit Basu
- Materials Research Centre, Indian Institute of Science, Bengaluru 560012, Karnataka, India; Translational Center on Biomaterials for Orthopaedic and Dental Applications, Indian Institute of Science, Bengaluru 560012, Karnataka, India; Centre for BioSystems and Engineering, Indian Institute of Science, Bengaluru 560012, Karnataka, India e-mails:
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Lim JW, Ridley D, Johnston LR, Clift BA. Acetabulum-Only Revision Total Hip Arthroplasty Is Associated With Good Functional Outcomes and Survivorship. J Arthroplasty 2017; 32:2219-2225.e1. [PMID: 28262454 DOI: 10.1016/j.arth.2017.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The coexistence of a stable femoral and a loose acetabular component may pose a clinical dilemma for the surgeon. Our study aims at comparing the intermediate functional outcomes and survivorship of acetabulum-only revision total hip arthroplasty (ArTHA) with an age-matched and gender-matched total revision THA (TrTHA) group. METHODS We retrospectively reviewed prospectively collected data on the pain, function, and total Harris Hip Scores (HHS) and complication profile for ArTHA and TrTHA cohorts from our regional arthroplasty database. Kaplan-Meier survivorship, with the need for repeat revision surgery as the end point, was used for survival analysis. RESULTS Among 538 cases, there were fewer acute medical complications in ArTHA and a similar dislocation rate for both cohorts. Preoperative HHS for pain, function, and total were better in the ArTHA cohort, but only the function score reached statistical significance. No significant differences in subsequent years for all aspects of HHS, except the function score was significantly better in the ArTHA cohort at year 1. And 10.0% of ArTHAs and 7.8% of TrTHAs had required rerevision. The 5-year survivorship was 90.3% (95% confidence interval ± 2.1%) for the ArTHA cohort and 92.7% (95% confidence interval ± 1.8%) for the TrTHA cohort (P = .394). The ArTHA with posterior approach (n = 118) group had the lowest dislocation rate and the best trend of functional outcomes. CONCLUSION ArTHA can provide similar functional outcomes and dislocation rate to TrTHA, with an acceptable rerevision rate. The posterior approach in this study was not associated with a significant dislocation rate.
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Affiliation(s)
- Jun Wei Lim
- Department of Orthopaedics and Trauma, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - David Ridley
- Tayside Orthopaedic and Rehabilitation Technology (TORT) Centre, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Linda R Johnston
- Tayside Orthopaedic and Rehabilitation Technology (TORT) Centre, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Benedict A Clift
- Department of Orthopaedics and Trauma, Ninewells Hospital and Medical School, Dundee, United Kingdom
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Optimized design for a novel acetabular component with three wings. A study of finite element analysis. J Surg Res 2013; 179:78-86. [DOI: 10.1016/j.jss.2012.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/08/2012] [Accepted: 08/20/2012] [Indexed: 02/01/2023]
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Taylor ED, Browne JA. Reconstruction options for acetabular revision. World J Orthop 2012; 3:95-100. [PMID: 22816064 PMCID: PMC3399017 DOI: 10.5312/wjo.v3.i7.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/31/2012] [Accepted: 07/10/2012] [Indexed: 02/06/2023] Open
Abstract
This article summarizes reconstruction options available for acetabular revision following total hip arthroplasty. A thoughtful methodology to the evaluation and treatment of patients with implant failure after joint replacement is essential to guarantee accurate diagnoses, appropriate triage to reconstruction options, and optimal clinical outcomes. In the majority of patients who undergo acetabular revision, factors such as bone loss and pelvic discontinuity provide a challenge in the selection and implementation of the proper reconstruction option. With advanced evaluation algorithms, imaging techniques, and implant designs, techniques have evolved to rebuild the compromised acetabulum at the time of revision surgery. However, clinical outcomes data for these techniques continue to lag behind the exponential increase in revision hip arthroplasty cases predicted to occur over the next several years. We encourage those involved in the treatment of patients undergoing hip replacement surgery to participate in well-designed clinical studies to enhance evidence-based knowledge regarding revision acetabular reconstruction options.
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Revisions of extensive acetabular defects with impaction grafting and a cement cup. Clin Orthop Relat Res 2011; 469:562-73. [PMID: 20931308 PMCID: PMC3018199 DOI: 10.1007/s11999-010-1618-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 09/24/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Loosening of acetabular components often leads to bony defects. Management of extensive acetabular bone loss in hip revision arthroplasty can be a tremendous challenge. QUESTIONS/PURPOSES We asked whether a reconstruction with impacted bone grafts will provide a durable and pain-free function in extensive acetabular defects. We specifically determined the (1) survival rates with the end point of revision for any reason, aseptic revision, and radiographic loosening; (2) visual analog scale (VAS) pain score, Harris hip score (HHS), and the Oxford Hip Questionnaire score (OHQS); (3) number of repeat revisions; (4) complications; and (5) radiographic loosening, wear, and radiolucencies. PATIENTS AND METHODS We retrospectively followed 25 patients (27 hips) with extensive acetabular defects. No patient was lost to followup. Two patients died during followup. Minimum followup was 3 years (mean, 8.8 years; range, 3-14.1 years). RESULTS Three patients (three hips) underwent repeat revision surgery and another two patients (two hips) had radiographically loose hips. The 10-year survival rate was 88% (95% confidence interval, 74.2%-100%) with the end point acetabular revision for any reason and 95% (95% confidence interval, 86.0%-100%) with the end point acetabular revision for aseptic loosening. The mean HHSs were 55 points before surgery and 72 points postoperatively. CONCLUSIONS Acetabular reconstruction with impaction bone grafting and a cemented cup is a reliable technique with a 10-year survival rate of 88% in patients with extensive acetabular deficiencies. LEVEL OF EVIDENCE Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
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Okano K, Miyata N, Enomoto H, Osaki M, Shindo H. Revision with impacted bone allografts and the Kerboull cross plate for massive bone defect of the acetabulum. J Arthroplasty 2010; 25:594-9. [PMID: 19493654 DOI: 10.1016/j.arth.2009.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 04/04/2009] [Indexed: 02/01/2023] Open
Abstract
We retrospectively reviewed 31 hips with massive bone defect because of aseptic loosening of the acetabulum treated with impacted bone allografts with the Kerboull-type acetabular device. Mean age at surgery was 67.9 years, and mean duration of follow-up was 6.3 years. Thickness of the bone graft was evaluated by postoperative radiography. Seven hips showed radiological failure associated with 6 breakages of the device, and 24 hips showed stability on follow-up radiographs. Of the 13 hips showing a bone graft thickness of greater than 20 mm on follow-up radiographs, 7 were classified as failure group. If an acetabular reinforcement device with a bone graft of more than 20 mm thickness is necessary, then a structural allograft should be considered in the weight-bearing area of the support ring in addition to the morselized bone graft.
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Affiliation(s)
- Kunihiko Okano
- Department of Orthopaedic Surgery, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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Lakemeier S, Aurand G, Timmesfeld N, Heyse TJ, Fuchs-Winkelmann S, Schofer MD. Results of the cementless Plasmacup in revision total hip arthroplasty: a retrospective study of 72 cases with an average follow-up of eight years. BMC Musculoskelet Disord 2010; 11:101. [PMID: 20507578 PMCID: PMC2887774 DOI: 10.1186/1471-2474-11-101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 05/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are multiple revision implant systems currently available for socket revision in revision total hip arthroplasty. Up until now, not all of these systems have been followed up with regards to their long-term use as a revision implantation.For the first time, this study presents the hemispherical porous-coated socket Plasmacup SC, produced by Aesculap, Tuttlingen, Germany, and the clinical and radiological mid-term results of this revision cup implant. METHODS Over a period of ten years the Plasmacup SC press-fit-cup was used as a revision implant in 72 consecutive aseptic cases which were included in this retrospective study. The mean follow-up period was 8 years. Bone graft transplantation was performed in 32% of all cases. In 90%, the cup was fixed with additional screws. The follow-up radiographs were analysed with regards to cup migration, osteointegration and osteolysis in the DeLee zones using a computer aided program taking the teardrop figure as a main point of reference. For clinical evaluation the Harris-Hip-Score and the WOMAC-Score were utilized. RESULTS At the follow up examination, the mean Harris-Hip-Score was 83.5 points and the mean WOMAC-Score 34.7 points. 93% of all patients were satisfied with the result of the operation. No aseptic cup loosening could be observed and only one cup had to be removed due to infection. No significant longitudinal or transversal cup migration could be observed. CONCLUSION Aesculap's Plasmacup SC is suitable as a cementless cup revision implant. There is stable cup osteointegration, post press-fit implantation, even in the case of major acetabular bone defects.
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Affiliation(s)
- Stefan Lakemeier
- Department of Orthopaedics and Rheumathology, Baldingerstrasse, 35043 Marburg, University Hospital Giessen and Marburg, location Marburg, Germany.
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Iwase T, Masui T, Torii Y, Kouyama A. Impaction bone grafting for acetabular reconstruction: mean 5.5-year results in Japanese patients. Arch Orthop Trauma Surg 2010; 130:433-9. [PMID: 19513736 DOI: 10.1007/s00402-009-0904-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We performed a retrospective outcome study on 23 consecutive acetabular reconstructions involving impaction bone grafting in Japanese patients. METHOD Two hips had cavitary defects, and 21 hips had combined segmental and cavitary defects. The mid-term follow-up was performed at a mean of 5.5 years postoperatively. The mean Merle d'Aubigné and Postel hip score had improved from 11.5 to 15.7 points at the final follow-up. Two hips showed migration at 30 months after surgery, and one of these was a candidate for re-revision due to symptomatic cup migration. RESULTS The Kaplan-Meier survival rate of the cup, with loosening and re-operation as the end points, was 91.3 and 95.7% at 5 years, respectively. CONCLUSION Acetabular impaction bone grafting is a reproducible technique in which surgeons should strictly follow the recommended technical procedure.
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Affiliation(s)
- Toshiki Iwase
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Shizuoka, 432-8580, Japan.
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Suh KT, Roh HL, Moon KP, Shin JK, Lee JS. Posterior approach with posterior soft tissue repair in revision total hip arthroplasty. J Arthroplasty 2008; 23:1197-203. [PMID: 18534511 DOI: 10.1016/j.arth.2007.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 08/08/2007] [Indexed: 02/01/2023] Open
Abstract
We investigated the influence of the posterior approach with soft tissue repair in revision hip arthroplasty by evaluating the rate of early posterior dislocation. Ninety-one patients (96 hips) who had undergone revision hip arthroplasty through the posterior approach were observed for 1 year or until dislocation occurred. Fifty-six revision hip arthroplasties were performed using the posterior approach with soft tissue repair technique. The results of these procedures were compared with those of 40 revision hip arthroplasties that had been performed using the posterior approach without soft tissue repair. The dislocation rate of 10.0% in 40 hips using the posterior approach without soft tissue repair was reduced to 1.9% in 56 hips using the posterior approach with soft tissue repair.
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Affiliation(s)
- Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University School of Medicine, Pusan, Republic of Korea
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Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg 2008; 128:545-50. [PMID: 18000673 DOI: 10.1007/s00402-007-0501-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Indexed: 02/06/2023]
Abstract
The treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiological outcome of revision THA using jumbo cups for acetabular reconstruction after applying the bone-grafting technique. We studied 17 patients with acetabular defects ranging from Type 2A to Type 3A according to Paprosky's classification. According to the AAOS-score twelve patients were classified as Type II and five patients as Type III. Uncemented press-fit cups with an outer diameter larger than 64 mm were used in all cases. Fifteen patients received morselized bone allografts. In eight patients an additional screw fixation was necessary. The mean follow-up period was 82 months (range 33-149). The mean Harris Hip Score was preoperatively 62 and at the time of the last follow-up examination 83 points (p = 0.007). Two acetabular components failed, one due to aseptic loosening and another one due to septic loosening. There was a trend of displacement of the femoral head centre towards the infero-lateral position after using jumbo cups that approached statistical significance (p = 0.065). Closure of acetabular defects of Types 2A to 3A according to Paprosky's classification and type II to III according to the AAOS-score respectively can be satisfactorily accomplished using jumbo cups after applying the bone-grafting technique.
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17
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Gul R, Jeer PJS, Oakeshott RD. Twenty-year survival of a cementless revision hip arthroplasty using a press-fit bulk acetabular allograft for pelvic discontinuity: a case report. J Orthop Surg (Hong Kong) 2008; 16:111-3. [PMID: 18453673 DOI: 10.1177/230949900801600126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acetabular revision in a total hip arthroplasty (THA) with pelvic discontinuity is uncommon and challenging. Optimal management remains controversial, particularly with graft and implant selection. Interpretation of outcomes is confounded by the heterogeneity of patterns of bone loss and the lack of long-term results in great numbers for any given choice of treatment. We report a revision THA using a press-fit bulk acetabular allograft and an uncemented porous-coated anatomic prosthesis for the management of pelvic discontinuity. After 20 years, the patient still had an excellent functional outcome with radiographic evidence of graft incorporation and no signs of loosening.
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Affiliation(s)
- R Gul
- Sportsmed SA, Adelaide, Australia.
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Wasielewski RC, Galat DD, Sheridan KC, Rubash HE. Acetabular anatomy and transacetabular screw fixation at the high hip center. Clin Orthop Relat Res 2005; 438:171-6. [PMID: 16131887 DOI: 10.1097/01.blo.0000165855.76244.53] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A quadrant system that defines the safe acetabular locations for screw placement exists for the anatomic hip center. We wanted to develop a similar system for the high hip center. The purposes of our study were to identify the anatomic structures at risk during placement of transacetabular screws in the high hip center, to identify maximum bone depth for screw purchase, and to determine if a high hip center quadrant system could be validated to guide placement of screws during acetabular arthroplasty. For this cadaver study of nine pelves, an acetabulum was reamed superiorly into the high hip center a distance equal to (1/2) of the native acetabular diameter. Screws exiting the acetabular bone by 15 mm were inserted before a computed tomography scan and a precise anatomic dissection were done. Structures at risk of penetration by screws include the external iliac vessels, the obturator nerve and vessels, the superior gluteal nerve and vessels, and the sciatic nerve. We found that a quadrant system at the high hip center can demarcate safe zones for screw placement. At the high hip center, only the peripheral (1/2) of the posterior quadrants are safe for screw placement.
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