An alternative treatment option for Paprosky Type IIIb acetabular defect using multiple tantalum wedges – A case report

Roßmann, Markus; Ansorge, Christian; Lausmann, Christian; Suero, Eduardo M.; Gehrke, Thorsten; Citak, Mustafa

doi:10.1016/j.jcot.2018.10.015

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Nevertheless, our results are promising given that few treatment modalities for anterosuperior medial bone loss have been described; in addition, a study on acetabular augments of similar composition (tantalum, Trabecular Metal ® ) including long-term follow-up with an estimated mean survivorship of 8.99 years has been reported 11) . Of note, only two other case reports have described the use of multiple porous metal acetabulum augments for management of Paprosky 3B defects, however, these two individual cases involved use of two different techniques (separate from the dome technique) and a follow-up period of less than two years 20 21) .…”

Section: Discussionmentioning

confidence: 99%

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes

et al. 2023

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Purpose The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.

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Section: Discussionmentioning

confidence: 99%

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes

et al. 2023

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“…Using multiple wedges for bone defect reconstruction has been described in a different way earlier with good preliminary results [ 22 ]. Though tantalum implants seem to have a quite high overall long-term survival [ 13 , 23 ], the weakness of these cases is a missing long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Acetabular Reconstruction Using Multiple Porous Tantalum Augments: Three-Quarter Football Augment

Ansorge

Ohlmeier

Ballhause

et al. 2022

Case Reports in Orthopedics

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Reconstruction of a large acetabular bone defect is a complex problem in revision hip arthroplasty. The authors report a novel method of reconstructing an uncontained acetabular defect (Paprosky type IIIb) using multiple tantalum augments. A 73-year-old female patient presented to our institution with a chronically dislocated primary left total hip arthroplasty with radiographs demonstrating migration of acetabular component and formation of pseudoarthrosis within the left ilium. Extensive arthrolysis and anatomic reconstruction of the acetabular bone defect were performed using the novel method of multiple tantalum augments. Postoperatively, recovery was initially complicated by multiple dislocations requiring an exchange to an elevated liner, however subsequently achieved good function.

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“…Currently, the most frequently used porous metal implants have either a tantalum or titanium porous metal surface and with press-fit implantation they provide a stable mechanical surface between implant and host bone in the short term (primary stability), and facilitate osseointegration in the mid and long term [6,7]. Tantalum in the form of Trabecular Metal™ (TM) (Zimmer Biomet, Warsaw, Indiana) is currently one of the more frequently used porous implants [8], and has been used to treat very extensive acetabular defects [9] as well as for neoplastic periacetabular lesions [10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Primary Stability of Porous Tantalum and Titanium Acetabular Revision Constructs

Beckmann

Bitsch²,

Schonhoff

et al. 2020

Materials

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Adequate primary stability of the acetabular revision construct is necessary for long-term implant survival. The difference in primary stability between tantalum and titanium components is unclear. Six composite hemipelvises with an acetabular defect were implanted with a tantalum augment and cup, using cement fixation between cup and augment. Relative motion was measured at cup/bone, cup/augment and bone/augment interfaces at three load levels; the results were compared to the relative motion measured at the same interfaces of a titanium cup/augment construct of identical dimensions, also implanted into composite bone. The implants showed little relative motion at all load levels between the augment and cup. At the bone/augment and bone/cup interfaces the titanium implants showed less relative motion than tantalum at 30% load (p < 0.001), but more relative motion at 50% (p = n.s.) and 100% (p < 0001) load. The load did not have a significant effect at the augment/cup interface (p = 0.086); it did have a significant effect on relative motion of both implant materials at bone/cup and bone/augment interfaces (p < 0.001). All interfaces of both constructs displayed relative motion that should permit osseointegration. Tantalum, however, may provide a greater degree of primary stability at higher loads than titanium. The clinical implication is yet to be seen

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An alternative treatment option for Paprosky Type IIIb acetabular defect using multiple tantalum wedges – A case report

Cited by 3 publications

References 16 publications

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes

Acetabular Reconstruction Using Multiple Porous Tantalum Augments: Three-Quarter Football Augment

Comparison of the Primary Stability of Porous Tantalum and Titanium Acetabular Revision Constructs

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