Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

Loppini, Mattia; Schiavi, Paolo; Rocca, Antonello Della; Traverso, F.; Rocca, Federico; Mazziotta, Giuseppe; Astore, F.; Grappiolo, Guido

doi:10.1177/1120700018813208

Cited by 16 publications

(25 citation statements)

References 23 publications

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“…Clinically, we found a significant and enduring improvement of the mHHS in our cohort at minimum 55months follow-up. Though the average score of 74.2 points at the latest follow-up is higher than previously described [3,10], it is lower than the mean score of 81 points of revision hip arthroplasty described by Löchel J et al [4]. After comparison the number of previous affected hip surgeries, we demonstrated that previous surgery is an important factor for mHHS score and Trendelenburg sign results.…”

Section: Clinical and Radiological Resultscontrasting

confidence: 73%

“…In present study, we found no patients underwent re-revision surgery for any reasons over the followup period ( Table 3). There is no significant difference about cup survival in comparison with literatures at the latest follow-up [3,10]. Clinically, we found a significant and enduring improvement of the mHHS in our cohort at minimum 55months follow-up.…”

Section: Clinical and Radiological Resultscontrasting

confidence: 43%

“…However, host bone would be widely removed if jumbo cups were used, and it would difficult to reconstruct with the residual bone stock at last. Aiming to fill the bone defects adequately and maximize the contact with the host bone, modular systems were widely used as a pragmatic tool by revision surgeons [10]. Though severe acetabular defects were handled in combination methods as literature reported, some special patients were difficult to handle with these existent combination techniques [3,10].…”

Section: Clinical and Radiological Resultsmentioning

confidence: 99%

“…Alternative techniques and implants should be considered to handle large and complex acetabular defects in the future. In recent years, a few studies have been carried out to evaluate the effects of a novel treatment strategy of double-cup technique applied to deal with Paprosky type Ⅲ acetabular defects without pelvic discontinuity, and the technique of double-cup reconstruction was considered as a credible way for acetabular revision based on their short-term results [3,10].…”

Section: Clinical and Radiological Resultsmentioning

confidence: 99%

“…However, poor results in revision hip arthroplasty using structural bone grafts without reinforcement devices have been reported [5]. Recently, some studies consider the technique of using custom-made implants in combination with trabecular metal prosthetic component was a reliable option to deal with severe acetabular defects [3,10]. However, to increase the function results, new strategy of using impacting bone grafting and other revision devices was recommended [11].…”

Section: Introductionmentioning

confidence: 99%

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Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

Zhang

Wan

Wang

et al. 2020

Preprint

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Background: Acetabular revision is often difficult to manage because of severe bone loss, especially for Paprosky type Ⅲ defects. Our present study aimed to assess the strategy of double-trabecular metal cups in acetabular revision.Methods: Fifteen patients (15 hips) underwent acetabular revision using double-cup technique alone or in combination with impacting bone grafting between January 2008 and May 2015. Preoperative and the latest follow-up clinical and radiographic scores were recorded and compared. Results:No patients were lost to follow up, and no patients underwent re-revision for loosening or any other reasons at the mean follow-up duration of 66 (range 55-105) months. We discovered 3 patients (3/15) with the early dislocation within the first year after the surgery and 2 patients (2/15) with delayed wound healing. The comparison between preoperative and the latest follow-up results showed the records of modified Harris Hip Score, University of California, Los Angeles activity score, Short Form 36, limb-length discrepancy and hip center of rotation were significantly improved. Conclusions:The application of double-cup technique alone or in combination with impacting bone grafting is an effective and reliable treatment option for Paprosky type Ⅲ acetabular defects without pelvic discontinuity.

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Section: Clinical and Radiological Resultscontrasting

confidence: 73%

Section: Clinical and Radiological Resultscontrasting

confidence: 43%

Section: Clinical and Radiological Resultsmentioning

confidence: 99%

Section: Clinical and Radiological Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

Zhang

Wan

Wang

et al. 2020

Preprint

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Bone remodeling after revision total hip arthroplasty for large acetabular defects

Ramesh,

Di Laura,

De Angelis

et al. 2024

Journal Orthopaedic Research

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Large acetabular bone defects are challenging in hip revision surgery. Clinical assessment is crucial to evaluate modern technologies in surgical reconstruction. We aimed to better understand the bone remodeling that occurs following acetabular reconstruction. Our objectives were: (1) To characterize changes in the shape of the pelvis by studying sequential computed tomography (CT) scans collected immediately and 1‐year postoperatively and (2) to identify which part of the pelvis is most susceptible to remodeling. We used the CT scans taken at two timepoints, of 24 patients with acetabular bone defects classified as Paprosky IIIB, treated with three‐dimensional (3D)‐printed custom‐made acetabular implants. Segmented 3D models of the bony pelvis were co‐registered using three different techniques. A global co‐registration of the full pelvis was conducted, followed by the co‐registration of the innominate bone and then ilium only, on the ipsilateral reconstructed side. The relative movements of the ilium, ischium, and pubis were analyzed from visual inspection and using co‐registration metrics (root mean square error and intersection over union). No bone remodeling was found in 14/24 patients (58%). The co‐registration of the innominate bone indicated bone remodeling in five cases (21%), while the remaining five cases (21%) presented remodeling in the global co‐registration but not the innominate bone co‐registration, suggestive of changes occurring at the sacroiliac joint. Changes in the pelvic shape were greatest at the pubis and ischium. Bone remodeling may occur in complex cases of Paprosky type IIIB defects, after acetabular reconstruction (occurrence of 21%, 5/24 cases). Surgeons and engineers should consider this when monitoring implant migration.

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Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

Burastero

Cavagnaro

Chiarlone

et al. 2020

International Orthopaedics (SICOT)

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Purpose Acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). Severe bone loss is not uncommon especially in periprosthetic joint infection. Surgical options, including revision shells, rings, and cages-with or without bone allograft-are affected by high complication rates and unsatisfactory clinical results. We report our mid-term results of non-flanged, custom-made acetabular components in staged rTHA. Methods We retrospectively reviewed all patients undergoing two-stage revision with acetabular custom-made implants between 2014 and 2016 at a single institution. Harris Hip Scores, Oxford Hip Scores, and Visual Analogue Scales for pain were obtained, and radiographical follow-up was performed. Complications were reported and analysed. Results We included 19 patients (19 hips) with an average follow-up of 42.3 ± 11.8 months. At the time of re-implantation, significant acetabular bone loss according to Paprosky classification (IIC, IIIA-B, and pelvic discontinuity) was detected in our patients. Clinical outcomes showed statistically significant improvement from pre-operative visit to last follow-up (p < 0.01). All custom-made implants had radiological osseointegration, and we did not find any implant complications, such as loosening or malposition. No mismatch between pre-operative planning and intra-operative findings was observed. To date, we report one septic failure managed with second staged revision, and one re-operation for recurrent THA dislocation. Conclusions Custom-made acetabular implants showed excellent clinical and radiographic mid-term outcomes with a low rate of related complications, providing implant stability on residual host bone, restoring hip biomechanics, and allowing biological osseointegration. Further long-term studies are needed to confirm preliminary results.

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Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity

Cited by 16 publications

References 23 publications

Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

Reconstruction of Paprosky III defects with double-trabecular metal cups in acetabular revision at five-year follow-up

Bone remodeling after revision total hip arthroplasty for large acetabular defects

Clinical study of outcomes after revision surgery using porous titanium custom-made implants for severe acetabular septic bone defects

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