Allogeneic Cancellous Bone Graft and a Burch-Schneider Ring for Acetabular Reconstruction in Revision Hip Arthroplasty

Winter, E.; Piert, Morand; Volkmann, R.; Maurer, F.; Eingartner, C.; Weise, K.; Weller, S.

doi:10.2106/00004623-200106000-00007

Cited by 143 publications

(102 citation statements)

References 24 publications

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“…Our functional outcome score at final followup as reflected in the HHS (mean, 44.2) is noticeably lower when compared with scores from previous studies that used the same measurement tool, with their scores ranging from 66 to 82.8 [27,35,37,41]. There may be two reasons for this.…”

Section: Discussioncontrasting

confidence: 69%

“…The results of cage reconstruction have been highly variable, ranging from 69% to 100% [5,6,14,21,23,25,27,34,37,41]. Unfortunately, few of these studies used survivorship analysis that would make it possible to Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Prior reports on the reconstructive cages have shown wide variability of results with cage survival ranging from 69% to 100% at varying times [5,6,14,21,23,25,27,34,37,38,41], complicating comparison with existing and future methods of reconstruction. This is partly attributable to nonactuarial methods and unclear definitions of end points (cage removal, any acetabular reoperation, or radiographic loosening) in estimating cage survivorship.…”

Section: Introductionmentioning

confidence: 99%

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Acetabular Cage Survival and Analysis of Factors Related to Failure

Sembrano

Cheng

2008

Clinical Orthopaedics &Amp; Related Research

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The reported results of acetabular cage reconstruction for pelvic deficiency are widely variable. Our primary question was: what is the survivorship of cage reconstruction with a primary end point of cage revision and secondary end points of radiographic loosening and any reoperation? Secondary questions were: which factors predict cage failure, and what is the functional outcome (SF-36, WOMAC, Harris hip score) of this reconstructive method? We reviewed 72 cage reconstructions in 68 patients. Minimum followup was 1.2 years (mean, 5.1 years; range, 1.2-10.7 years). Five-year cage revisionfree survivorship was 87.8%. Five-year loosening-free and acetabular reoperation-free survivorships were 80.7% and 81.3%, respectively. No single preoperative factor (age, gender, severity of pelvic defect, degree of heterotopic ossification, difference in limb lengths and centers of rotation) or intraoperative factor (type of bone graft, type of cage, changes in limb length and center of rotation) predicted cage failure. Functional outcomes were 28.9 (SF-36 Physical Component), 52.4 (SF-36 Mental Component), 33.7 (WOMAC), and 44.2 (Harris). We judged these outcomes acceptable for this sometimes challenging problem.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acetabular Cage Survival and Analysis of Factors Related to Failure

Sembrano

Cheng

2008

Clinical Orthopaedics &Amp; Related Research

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“…Recent papers [24,25,26] have, however, patient groups comparable to ours. Using the AAOS classification [4] we found 64% type III defects, which in the literature ranges from 22% [8] to 100% [1].…”

Section: Discussionsupporting

confidence: 62%

Revision cup arthroplasty using Burch-Schneider anti-protrusio cage

Koeveringe

Ochsner

2002

International Orthopaedics

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From 1986 until 1995 we used the BurchSchneider anti-protrusio cage in 31 patients (33 hips) and followed the patients for 5 years. Five patients died within the 5-year follow-up. Clinical outcome listed an average Harris hip score of 71/70/66 points after 1, 2 and 5 years respectively. One patient had a revision due to late-onset haematogenous infection. We found cup migration in nine patients. Migration was self-limiting in three cases and in two there was no bony graft ingrowth. Screw breakage was seen in one case. All migrated cages showed a higher rotational centre than cages without migration.Résumé Entre 1986 et 1995 nous avons utilisé l'anneau anti-protrusion de Burch Schneider chez 31 malades (33 hanches) qui ont été suivis 5 années. Cinq malades sont morts dans ce délai. Le résultat clinique donne un score moyen de Harris de 71/70/66 points après respectivement 1, 2 et 5 années. Un malade a eu une révision à cause d'une infection hématogène à début tardif. Nous avons trouvé une migration de la cupule chez 9 malades. La migration s'était limitée spontanément dans trois cas. Dans deux cas il n'y avait aucune réhabitation de la greffe. Une rupture de la vis a été vue dans un cas. Toutes les cupules ayant migré avaient un centre rotationnel plus haut situé que les cupules sans migration.

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“…Impaction grafting techniques may be inadequate for stabilizing pelvic discontinuity and do not typically provide adequate acetabular component stability in cases in which major portions of the anterior and posterior columns are absent [30,34,35]. Even conventional off-the-shelf cages with structural allografts have had reported relatively high rates of short-and medium-term mechanical failures (from 12.5% to 37.5%) [11,13,23,28,29,31,37]. Furthermore, the variability in the shape of the pelvis and in the size and shape of acetabular defects often results in a relatively poor fit of the off-the-shelf cage to host bone; this is important, because achieving cage stability on host bone is the main challenge in using acetabular reconstruction cages.…”

Section: Introductionmentioning

confidence: 99%

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Mao

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes morestraightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach. Questions/purposes For patients with severe (Paprosky IIIB) defects, we asked: do individualized custom cages result in (1) improved Harris hip scores; (2) restoration of hip center; and (3) a low incidence of surgical complications? Methods Twenty-six patients (26 hips) with a massive acetabular defect were involved in this study from 2003 to 2013. During this period, one patient was lost to followup and one died, leaving 24 patients (eight males, 16 females) in this retrospective analysis. The customized cages were individualized to each patient's bone defect based on rapidprototype three-dimensional printed models. Mean followup was 67 months (range, 24-120 months). Harris hip scores were assessed before surgery and at each followup. Postoperative radiographs were evaluated for cage position, migration, and graft incorporation. Complications and reoperations were assessed by chart review. Results The mean Harris hip score improved from 36 (SD,8; range, to 82 (SD, 18; range, 60-96) (p \ 0.001). Individualized custom cages resulted in generally reliable restoration of the hip center. No rerevisions have been performed. None of the cups showed radiographic migration, but one cage was believed to be loose, based on a circumferential 2-mm radiolucent line. Cancellous allografts appeared to be incorporated in 23 of 24 patients. One deep infection and one superficial infection were observed and treated with irrigation, débridement, and vacuumsealing drainage. One dislocation and one suspected injury of the superior gluteal nerve also were observed and treated conservatively. Conclusions Individualized custom cages using rapid prototyping and three-dimensional printing appeared to provide stable fixation and improved hip scores at shortterm followup in this small, single-center series. As further improvements in the design and manufacturing process are made, future studies should evaluate larger patient groups for longer times, and, ideally, compare this approach with alternatives for these complex bone defects.

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Allogeneic Cancellous Bone Graft and a Burch-Schneider Ring for Acetabular Reconstruction in Revision Hip Arthroplasty

Cited by 143 publications

References 24 publications

Acetabular Cage Survival and Analysis of Factors Related to Failure

Acetabular Cage Survival and Analysis of Factors Related to Failure

Revision cup arthroplasty using Burch-Schneider anti-protrusio cage

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

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