Latent Period Best Predicts Acetabular Cup Failure after Total Hip Arthroplasties in Radiated Hips

Abstract

Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Tantalum Acetabular Cups Provide Secure Fixation in THA after Pelvic Irradiation at Minimum 5-year Followup

“…Our study involved a diverse population (Table 2), thus improving the generalizability of the study. The uniform survivorship of the implants in this study was in contrast to most prior reports [4,10,15]. This may have been secondary to the combination of the bone ingrowth and biomechanical properties of porous tantalum we used.…”

“…Most studies have shown high rates of fixation failure with conventional implants [4,10,15]. The reported acetabular loosening rates of 44% to 52% at 2 to 6 years [10,15] highlighted the difficulty in obtaining durable acetabular fixation in this patient population.…”

“…Radiotherapy has also reportedly caused accelerated degenerative arthritis, leading to substantial pain and disability [7,19]. Degenerative joint disease in the presence of prior pelvic radiation has been a difficult problem to treat; traditional THA components have shown rates of early implant loosening of between 44% and 52% at 2 to 6 years using both cemented and uncemented components [4,10,15] (Table 1).…”

A cemented acetabular component with a reinforcement cross provides excellent medium-term fixation in total hip arthroplasty after pelvic irradiation

“…7 Conventional total hip arthroplasty (THA) after radiotherapy is associated with frequent and early failure of the acetabular component. The reported rates of loosening, between two and six years post-operatively, range from 44% to 52% for both cemented and uncemented components [8][9][10] (Table I). The reasons for the failure of cemented acetabular components include inadequate interdigitation of the cement with dense and sclerotic bone and insufficient trabecular support over time.…”

“…Some authors have used a reinforcement device to reduce the rate of failure with moderate success. [8][9][10] The failure of uncemented components is due to the difficulty in achieving primary stability in bone that is poorly elastic, has decreased capability for osseous integration and has limited ability to remodel over time. 9 Trabecular metal reconstruction has given good early results.…”