Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation

Schmolders, Jan; Friedrich, M; Michel, Robert D.; Randau, Thomas M.; Wimmer, Matthias; Strauß, Andreas C.; Kohlhof, Hendrik; Wirtz, Dieter Christian; Gravius, Sascha

doi:10.1007/s00264-014-2533-5

Cited by 20 publications

(13 citation statements)

References 36 publications

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“…Although many approaches have been developed, such as revision with jumbo acetabular components, oblong cups, structural grafts, reinforcement rings, antiprotrusio cages, and cementless modular revision system, there are few reliable options [1][2][3][4]. Furthermore, despite greatly enhancing the surgeon's ability to reconstruct severely compromised acetabula, the recently developed porouscoated or ultraporous metal cups, shells, and augments do not fully recapitulate the lost bone [5,6].…”

Section: Introductionmentioning

confidence: 95%

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

Mao

et al. 2015

International Orthopaedics (SICOT)

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Section: Introductionmentioning

confidence: 95%

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

Mao

et al. 2015

International Orthopaedics (SICOT)

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“…Bei der Behandlung dieser Patienten sollte das Erreichen einer primär stabilen Gelenksituation eines der Hauptziele sein, da Patienten zum Zeitpunkt einer Revision meistens älter sind und oft eine hohe Rate an Komorbiditäten aufweisen [9,10,12,[17][18][19][20][21][22].…”

Section: Diskussionunclassified

“…Die biologische Defektaugmentation mit z. B. allogener Spongiosa liefert bei kleineren ossären Defekten sowohl am Becken als auch am Femur vielversprechende Ergebnisse [10][11][12]23]. Ein Restrisiko für eine Infektion besteht jedoch trotz Sterilisationsverfahren mittels Bestrahlung weiterhin.…”

Section: Diskussionunclassified

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Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

et al. 2016

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With extended life expectancy, the number of primary joint arthroplasties has also increased. Revision surgery is also more often necessary, due to aseptic or septic loosening of the prosthesis or periprosthetic fracture. Large bone defects often occur in these patients and several non-modular, conventional implants are available to handle this difficult situation. Custom made implants offer an individually designed and defect-adapted shape with perfect covering of the lesion, but may delay the operation. The Modular Universal Tumor And Revision System (MUTARS®) offers the possibility to vary the length and angle of the femoral neck and the antetorsion angle. Thus, it permits intraoperative adaption to the individual patient's defect. The aim of our study is to present clinical, functional results and the rate of complications in a cohort of patients undergoing revision surgery for failed endoprosthetic replacement or failed trauma surgery, using the Modular Universal Tumor And Revision System with short-to midterm follow-up. Between August 2005 and September 2014, 25 patients (17 female, 8 male) with an average age of 72 years (min. 56, max. 92 years) were included in a retrospective study using the MUTARS® system. The patients underwent surgical revision of osseous defects that were not susceptible to conventional care. The mean follow-up was 16 months (min. 12, max. 72 months). The indications which led to revision surgery were as follows: loosened metal-on-metal prosthesis with an acetabular defect caused by a metal-induced granuloma (n = 1), pseudoarthrosis after implantation of femur nail (n = 2), cut-out of a femur nail (n = 1), aseptic loosening of an implanted endoprosthesis (n = 4), septic loosening of an implanted endoprosthesis (n = 1), periprosthetic fracture (n = 6) and periprosthetic infection after two stage revision surgery (infection consolidated Girdlestone situation) (n = 10). All patients were followed up at regular intervals, both clinically and radiologically. Apart from comorbidities, clinical and functional parameters were measured, including the Harris Hip Score. An outcome analysis was also performed with respect to peri- and postoperative complications. Serial plain X-rays were followed-up. In all patients, stable reconstruction without the use of an allograft was possible. In total, 23 patients underwent surgery by using a proximal femur prosthesis; three patients also received a custom made acetabular component. One patient was treated by using a distal femur and one patient was treated by implantation of a total femur prosthesis. The average length of hospital stay was 25 days (min.11, max. 47 days). The Harris Hip Score improved from 28 points preoperatively to 81 points after surgery.In total we recorded 24 % of complications after surgery. Two patients suffered recurrent periprosthetic infection and the prosthesis had to be revised in a further two stage exchange; one patient had a tractus gap and was revised by surgery. Two patients suffered periprosthetic fracture due to trauma...

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“…The subsequent loss of periacetabular bone stock in such cases is the main problem in acetabular revision surgery. 2,3 In severe cases of bone loss, implantation of a "custom-made acetabular component" (CMAC) is, therefore, needed as an individualised treatment strategy. Especially in old and multimorbid patients, treatment failure may necessitate a permanent girdlestone arthroplasty, with severe reduction in mobility.…”

Section: Introductionmentioning

confidence: 99%

Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series

et al. 2020

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Background: Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a “second” rTHA with “custom-made acetabular components (CMACs)” after a previously failed reconstruction with CMACs. Methods: 4 patients with severe acetabular bone loss (Paprosky Type IIIB), who required a second rTHA after a previously failed reconstruction with CMAC, due to prosthetic joint infection (PJI), were included in our retrospective study. All prostheses had been constructed on the basis of thin-layer computed-tomography scans of the pelvis. The second rTHA was considered unsuccessful in the event of PJI or aseptic loosening (AL) with need for renewed CMAC explantation. Results: The treatment success rate after second rTHA with a CMAC was 50% (2 of 4). In the successful cases, the visual analogue scale (VAS) score and Harris Hip Score (HHS) after the second rTHA (VAS range 2–4; HHS range 45–58 points) did not differ from those after the first rTHA, before onset of symptoms (VAS: range 2–4; HHS: range 47–55 points). In the failed cases, the second CMACs needed to be explanted due to PJI, with renewed detection of previous pathogens. Patients with treatment failure of the second CMAC had required a higher number of revision surgeries after explantation of the first CMAC than patients with a successful outcome. Conclusions: In patients with severe acetabular bone loss and previously failed rTHA with CMACs, repeat rTHA with a CMAC may be a solid treatment option for patients with an “uncomplicated” multi-stage procedure, i.e., without persisting infection after explantation of the original CMAC. While the outcome in terms of clinical function does not appear negatively affected by such a “second attempt,” the complication rate and risk of reinfection, nonetheless, is high.

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Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation

Cited by 20 publications

References 36 publications

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

Tumorprothesen in der endoprothetischen Revisionschirurgie der unteren Extremität – Ergebnisse von 25 Patienten nach Versorgung mit einem modularen Tumor- und Revisionssystem (MUTARS®)

Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series

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