Extra-Large Uncemented Hemispherical Acetabular Components for Revision Total Hip Arthroplasty

Whaley, Andrew L.; Berry, Daniel J.; Harmsen, William S.

doi:10.2106/00004623-200109000-00010

Cited by 214 publications

(139 citation statements)

References 22 publications

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“…However, these provide poor results when acetabular bone defects are greater than 50%, particularly if the posterior column and the dome are not intact [11]. Other options are available, including extralarge components [41], antiprotrusio cages [1], and trabecular metal devices [20]. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision THA.…”

Section: Discussionmentioning

confidence: 99%

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

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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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

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Section: Discussionmentioning

confidence: 99%

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

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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“…In this study, the decision on the treatment option for surgical reconstruction was made by each surgeon independently. Seventeen patients were treated with a jumbo cup as defined by Whaley et al [15] and five patients were treated with impaction bone graft and a cemented cup. One patient was treated with high placement of the acetabular component without cement as described by Dearborn and Harris [16] and another patient was treated with a cage and cup reconstruction.…”

Section: Methodsmentioning

confidence: 99%

Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: Martell radiographic analysis

Choi

Anderson

Foster

et al. 2013

International Orthopaedics (SICOT)

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Purpose This study evaluates acetabular cup position in the setting of revision total hip arthroplasty (THA) with severe acetabular bone defects. Methods With a definition of safe zone of abduction (30-50°) and anteversion (5-25°), acetabular cup position was measured by a digital image analysis program for 34 patients with Paprosky type III acetabular bone defects. Results There were 24 cups (71 %) for abduction and 26 cups (76 %) for anteversion located in the safe zone. Nineteen cups (56 %) were within the safe zone for both abduction and anteversion. There was no dislocation, however one cup out of the safe zone resulted in early cup failure due to aseptic loosening. Conclusions The acetabular cup positioning in patients with Paprosky type III defects was 'optimal' in half of the cases. The prevalence of optimal acetabular cup position was similar to those reported in primary THA, suggesting that the presence of a large acetabular bone defect may not be a significant risk factor for suboptimal acetabular cup positioning in the setting of revision THA.

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“…If the defect is uncontained and too large, sufficient contact with host bone will not be achieved with this tactic and therefore sufficient stability to allow bone ingrowth will not be achieved [18]. Alternatives include impaction allografting with cement with containment created by the use of rim meshes [16,34], the use of bulk allografts [32], bilobed acetabular components [7], jumbo acetabular components [11,40], high placement of the hip center of rotation [10], or the use of a reconstruction cage [17].…”

Section: Introductionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

107

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Background Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. Questions/purposes The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. Methods Between 2002 and 2005, we performed 56 revision (n = 53) and primary (n = 3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined.

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Extra-Large Uncemented Hemispherical Acetabular Components for Revision Total Hip Arthroplasty

Cited by 214 publications

References 22 publications

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

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

Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: Martell radiographic analysis

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

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