Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up

Abstract

AIMTo evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODSFifty-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.RESULTSThe 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.CONCLUSIONThe medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.

Do Acetabular Buttress Augment Pose Risk to the Superior Gluteal Nerve? A Cadaveric Study

“…Hemispherical porous coated acetabular cups alone may not be reliable for stable fixation [ 3 ]. Oblong cups, or “jumbo cups” (those with a minimum diameter of 66 mm in men or 62 mm in women), can result in destruction of the posterior column due to the asymmetry of bone loss [ 25 ]. The use of structural allograft and bone substitutes with reconstruction cages is difficult to fix biologically and has poor longevity [ 25 ].…”

“…Oblong cups, or “jumbo cups” (those with a minimum diameter of 66 mm in men or 62 mm in women), can result in destruction of the posterior column due to the asymmetry of bone loss [ 25 ]. The use of structural allograft and bone substitutes with reconstruction cages is difficult to fix biologically and has poor longevity [ 25 ]. In addition, morselized bone grafting used in conjunction with cemented components may result in iatrogenic fractures and loss of component position.…”

“…These implants are designed for ingrowth and are thus void of the potential for resorption and disease transmission and are structurally sound. Buttress augments used in conjunction with revision acetabular cups (ie, multihole and larger sizes with biologic metal) can restore very well the natural hip center and improve gait mechanics [ 5 , 25 , 26 ]. This center of rotation has been shown to be lowered as much as 3.5 centimeters from preoperative values in revision cases [ 2 ].…”

Nae Ionescu’s 1938 Legionary Phenomenon: A “Missing Link” between Evola and Dugin

“…65 According to Evola, "The idea that the power to govern is conferred on the chief by those whom he rules and that his authority is the expression of the community and therefore subject to its decrees, was foreign to Tradition." 66 Similarly, according to Ionescu: At the basis of the [democratic] understanding of the world is the individual will and not the will of the nation, in the sense of collectivity, entity, synthesis, sum. Democracy did not speak about the will of the nation, for the nation is a collective being.…”

Hip Arthroplasty in Patients with Hip Dysplasia by Individual Augments: Early Results

“…Эффективным методом реконструкции дефектов вертлужной впадины при дисплазии является применение аугментов из трабекулярного металла [21,22]. Данные материалы в отличие от кости не подлежат лизису и показывают хорошие результаты в отношении остеоинтеграции, прочности и биосовместимости [5, 23,24,25,26].…”