Acetabular Revision with Metal Mesh, Impaction Bone Grafting, and a Cemented Cup

Buttaro, Martín; Comba, Fernando; Pusso, Rodolfo; Piccaluga, Francisco

doi:10.1007/s11999-008-0442-x

Cited by 92 publications

(87 citation statements)

References 52 publications

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“…Jumbo cups have been associated with favorable survivorship of 92% to 96% at 14 to 16 years [19,27] where adequate support can be obtained. Acetabular impaction grafting has shown promising results with 87% survivorship for aseptic loosening at 20 years and 75% for any cause of failure [30]; however, it is technically demanding, time-consuming, and may be associated with higher failure rates in massive bone loss [6]. Combining the technique with trabecular metal augments to support large areas of graft offers promising early results [15].…”

Section: Discussionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

107

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Background Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. Questions/purposes The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. Methods Between 2002 and 2005, we performed 56 revision (n = 53) and primary (n = 3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined.

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Section: Discussionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

107

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“…Concerns over migration and early failure remain with the use of impaction morselized allograft for uncontained acetabular segmental defects [1,23]. The survivorships associated with the use of Impacting bone grafting reinforcement ring were between 80 and 90% but with only 6 years mean followup duration [6,18].…”

Section: Discussionmentioning

confidence: 99%

“…For Type 3 uncontained acetabular bone loss in which there is more than 30% but less than 50% acetabular bone loss, options for acetabular reconstruction include the use of impaction bone grafting [1,23], acetabular reinforcement ring [6,18], oblong cup [8,10], uncemented cup with high hip center [13], structural allograft (minor column or shelf graft) [20,25], and trabecular metal cup with augment [11,19,21,24]. Concerns have been expressed over early component migration and failure with impaction bone grafting in uncontained segmental acetabular bone defects.…”

Section: Introductionmentioning

confidence: 99%

“…Concerns have been expressed over early component migration and failure with impaction bone grafting in uncontained segmental acetabular bone defects. Van Haaren et al [23] reported a 72% survivorship at a mean followup of 7 years (1.6-10) with revision for aseptic loosening as endpoint and Buttaro et al [1] reported a 91% survivorship (n = 23) at a mean followup of 3 years (2-5) with 2 mm or more migration seen in all cups (median 3 mm, range, 2-25 mm). Acetabular reinforcement rings reportedly have more than 80% cup survivorships at 10 years [6,18].…”

Section: Introductionmentioning

confidence: 99%

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Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty

Lee

Raz²,

Safir³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background While acetabular structural allografts provide an important alternative for reconstructions, concerns remain with long-term graft resorption, collapse, and failure. Midterm studies of minor column (shelf) allograft suggest reasonable survival but long-term survival is unknown. Questions/purposes We therefore assessed long-term graft/cup survivorship, functional scores, radiographic resorption, and complications associated with minor column allograft. Methods We retrospectively reviewed 74 patients (85 hips) with a mean age of 54 years (range, 28-83 years) undergoing acetabular cup revision using a minor column allograft. A minor column allograft was used in uncontained acetabular bone defects sized between 30% and 50% of the acetabulum. Graft failure was considered to occur when the graft required revision with another graft, metal augment, reconstruction cage, or excision arthroplasty. The minimum followup was 5 years (mean, 16 years; range, 5.3-25 years). Results Twenty-three patients (27 hips) had rerevision for all causes at a mean time to rerevision of 6.9 years (range, 0.1-23). Fifteen grafts failed at a mean time-to-rerevision of 6.1 years (range, 0.5-23.2). The 15-and 20-year Kaplan-Meier survivorships were 61% and 55% for cups and 78% for grafts with rerevision for all causes as end point. With rerevision for aseptic loosening as end point, survivorships were 67% and 61% for cups and 81% for grafts. The mean modified Harris hip scores were 41 (range, 20-60) preoperatively, 73 (range, 40-95) at 1 year postoperatively and 73 (range, 26-93) at last followup.

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“…Managing severe acetabular bone defects during revision hip arthroplasty remain a great challenge, are controversial, and many different options are used, such as: impaction bone grafting with reinforcement ring and cemented cup [8], metal mesh & impaction bone grafting and cemented cup [9], acetabular reinforcement ring [10,11], oblong cup [12,13], uncemented cup with high hip center [14], structural allograft with reinforcement devices [15], tantalum trabecular metal™ o trabecular titanium™ cups with augment [16][17][18] . The main advantage of using allografts is that you can adjust the graft to the defect, and we keep its use for some complex cases, especially in the young patient, in which a restoration of the bone stock is desirable for the future.…”

Section: Acetabular Defects In the Revision Total Hip Arthroplastymentioning

confidence: 99%

Perspectives about the Use of Autografts and Allografts for the Acetabular Component of a Total Hip Arthroplasty

Fernández-Valencia¹

2016

MOJOR

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Acetabular Revision with Metal Mesh, Impaction Bone Grafting, and a Cemented Cup

Abstract: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 92 publications

References 52 publications

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty

Perspectives about the Use of Autografts and Allografts for the Acetabular Component of a Total Hip Arthroplasty

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