Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review

Background: As opposed to rim xation, 3-point xation provides su cient primary stability for cememless cups in the presence of massive bony de ciency. While several methods, including doming augments or ying buttress augments, have been introduced to reconstruct superior supportive points, good methods to establish supportive ischiopubic points are currently lacking. The aims of this study were to introduce the de nition, indication and surgical technique of extended ischiopubic xation (EIF) and to investigate the early clinical and radiographic results and complications of hips revised with EIF.Methods: Patients who underwent revision THA utilizing the technique of EIF with porous metal augments secured in the ischium and/or pubis in a single institution from February 2015 to February 2020 were retrospectively reviewed. 25 patients were included based on the criteria of minimum 2-year follow-up. The median duration of follow-up was 48.06 months (interquartile range: 41.37-62.20 months).The patients' clinical results were assessed using of the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis index and any complications including infection, intraoperative fracture, dislocation, postoperative nerve palsy, hematoma, wound complication and/or any subsequent reoperation(s) were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation and cup orientoration.Results: At the most recent follow-up, 20 (80%) patients rated their satisfaction level as "very satis ed", 5 (20%) were "satis ed". The median HHS score improved from 36.00 preoperatively to 81.00 (p 0.001) while the median WOMAC index score decreased from 74.50 preoperatively to 16.50 at the latest followup (p 0.001). No intraoperative or postoperative complications were identi ed. All constructs were considered to have obtained stable xation. The median vertical and horizontal distance between the latest postoperative center of rotation to the anatomic center of rotation improved from 13.62 mm and 8.68 mm preoperatively to 4.42 mm and 4.19 mm, at nal follow-up (p<0.001), respectively. Conclusions: Early follow-up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable xation and restoration of the center of rotation.

Section: Discussionmentioning

confidence: 99%

Extended Ischiopubic Fixation Using Porous Metal Augments in Cementless Acetabular Reconstruction during Revision Total Hip Arthroplasty

Huang

Tang

Zhou

et al. 2022

“…32 The post-revision clinical/functional subjective scores were significantly higher than those before surgery. 33 The Outcome of Prosthesis Revision with IBG and Ti-Alloy Mesh In this study, we retrospectively analyzed the clinical data and discussed the outcomes of prosthesis revision using IBG combined with Ti-alloy mesh for acetabular reconstruction. There was a long-term follow-up period of 109 AE 27.86 months for the patients in this study.…”

Section: Discussionmentioning

confidence: 99%

“…IBG can fill the defect and increase the amount of bone in the acetabulum; support the Ti‐alloy mesh for bone graft fixation, which aids in varied direction of screw fixation and bone cement infiltration; reduce stress shelter and effectively restore anatomical structure of acetabulum; and disperse the pressure of the acetabulum load 32 . The post‐revision clinical/functional subjective scores were significantly higher than those before surgery 33 …”

Section: Discussionmentioning

confidence: 99%

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Impaction Bone Grafting Combined with Titanium Mesh for Acetabular Bone Defects Reconstruction in Total Hip Arthroplasty Revision: A Retrospective and Mini‐Review Study

Pan

et al. 2022

Objective To investigate the application of impaction bone grafting (IBG) combined with Ti‐alloy mesh for acetabular bone defect reconstruction in total hip arthroplasty (THA) revision and follow up the clinical outcomes and imaging findings. Methods The clinical and imaging data of patients who were admitted to our hospital from January 2000 to December 2020 and underwent acetabular bone defects reconstruction using IBG combined with titanium mesh were retrospectively analyzed. Preoperative and post‐revision Oxford and Harris scores, and post‐revision complications were evaluated. Radiographs were used to determine center of rotation (COR) of the hip joint, transparency line, bone graft fusion, and bone mineral density (BMD) around the hip joint. Results Significant improvement was observed in both Oxford and Harris scores (P < 0.05). The radiographs taken at the last follow‐up examination showed no significant differences in the acetabulum COR, offsets, inclination angle, mean ratio of vertical value, and BMD analysis between the post‐revision side and contralateral side (P > 0.05). The follow‐up data showed restoration of the mesh implant and graft bone fusion. Conclusions The application of IBG combined with titanium‐alloy mesh in revision THA patients with acetabular defects was found to provide satisfactory outcomes. However, large‐scale studies are still needed to further elucidate the long‐term outcomes.

“… 7 It involved the use of autografts or allografts bone impacted into defects and metal meshes to convert uncontained defects into contained ones. 8 Compared with other techniques, the important advantage of IBG is that it can restore bone stock through osteointegration and therefore facilitates future revisions, especially for younger patients. 9 , 10 Combined with a cemented cup, the technique can reconstruct the bone bed to provide immediate biomechanical stability and permit early weight bearing.…”

Section: Introductionmentioning

confidence: 99%

Impaction Bone Grafting with Low Dose Irradiated Freeze‐Dried Allograft Bone for Acetabular Reconstruction

Tan

et al. 2022

Objective: Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium-term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population.Methods: This was a single-center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze-dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior-posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow-up. Independent sample ANOVA test and Pearson chi-square tests are used for statistical analysis.Results: There were 61 hips in 57 patients. The average follow-up time was 35.59 months (5-77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32-58) preoperatively to 86.98 (range: 78-93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during followup. Although one cup migrated, no revision, re-revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow-up.Conclusions: IBG with low-dose irradiated freeze-dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.