Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results.

Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular-revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

“…All postoperative and followup radiographs were made at our institution following the same protocol [18]. Measurements were made by a single author (EG-R).…”

Section: Methodsmentioning

confidence: 99%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

“…All radiographs were evaluated according to the recommendations of Johnston et al [13]. Implant stability was classified as bony ingrown, fibrous stable, or unstable according to the classification of Engh et al [9].…”

Section: Methodsmentioning

confidence: 99%

Modular Femoral Sleeve and Stem Implant Provides Long-term Total Hip Survivorship

Smith

Tanzer

et al. 2011

“…Impending failure was radiographic evidence of loosening without revision. Femoral radiolucent lines and osteolysis were reported in each of seven Gruen zones on the anterior-posterior and lateral radiographs [14,17].…”

Section: Methodsmentioning

confidence: 99%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Large-diameter metal-on-metal articulations reportedly provide better stability and range of motion than smaller diameter bearings. We therefore asked whether a large-diameter (44-to 50-mm) metal-on-metal articulation (Durom1) would eliminate dislocation and provide similar functional scores and clinical and radiographic failure rates as those with 28-mm articulation. We prospectively followed 181 patients (207 hips) who had a large-diameter articulation implanted between May 2006 and November 2007. We compared these patients with a historical control of 54 patients who had a small-diameter (28-mm Metasul1) articulation. All patients had a Harris hip score and a self-assessment of outcome and radiographic followup. The minimum followup was 1 year (mean, 1.6 years; range, 1-2 years). During the followup period, we performed revisions on 29 patients (30 hips [15%]) with 21 of 29 (72%) having radiographic criteria of loosening. Thirteen retrieved cups and acetabular tissue were examined histologically. Twenty-eight of 151 unrevised patients had radiographic impending failure; 12 without revision had clinical failure. Eight patients (nine hips) had both clinical failure and impending radiographic failure. Cup inclination was 41.3°± 5.4°and anteversion was 20.2°± 7°. The revision rate and quality of clinical results were unacceptable as compared with our historical controls. We do not recommend use of the Durom1 implant.