Use of the Burch–Schneider cage and structural allografts in complex acetabular deficiency: 3‐ to 10‐year follow up

Abstract

This study aimed to evaluate retrospectively the clinical outcomes and complications of structural allografts and Burch-Schneider antiprotrusio cages to treat severe acetabular defects in revision total hip arthroplasty (THA). Between July 2003 and December 2010, 29 patients (representing 31 hips) underwent revision THA using structural allografts and Burch-Schneider cages for acetabular reconstruction. The patients had a mean age of 59 years (range, 37-79 years). Seventeen hips had a Paprosky IIIA defect, 12 hips had a IIIB defect, and two hips had a pelvic discontinuity (PD) acetabular defect. After a mean follow up of 5.5 years (range, 3.0-10.5 years), all patients, except for two patients with recurrent infections, significantly improved, based on the mean Harris hip score (30 points vs. 67 points, p < 0.001) and the Western Ontario and McMaster Universities Arthritis index (WOMAC) score (65 points vs. 32 points, p < 0.001). Using re-revision surgery as the endpoint, the cage had a survival rate of 76% [95%, confidence interval (CI), 67.4-84.6%] at 5 years and 57% (95% CI, 39.3-74.7%) at 10 years. Other complications included hip dislocation [3 (9.7%) hips]; deep infection [3 (9.7%) hips]; and sciatic nerve impingement, vesicle-acetabular fistula, and leg lengthening [1 (3.2%) hip]. There was a trend toward a higher failure rate in hips with four revisions, compared to hips with three revisions or fewer (p = 0.055). Three hips with a failed cage underwent re-revision surgery using a standard noncemented acetabular component. In conclusion, a structural allograft with Burch-Schneider antiprotrusio cage for complex acetabular defect is a technique-demanding procedure with a 5-year survival rate of 76%. Even with failed cage reconstruction, re-revision surgery with a noncemented acetabular component may be feasible once the allograft has healed.

Stress analysis of a Burch-Schneider cage in an acetabular bone defect: A case study

“…The outcome of this study corresponds with the findings in literature: sufficient support should be available for long-term stability of a Burch-Schneider cage [6,8,9,10]. These findings were based on the relatively high failure rates of cages in Paprosky IIIB defects compared to smaller defects.…”

“…Selecting a suitable treatment option for each patient is essential in order to avoid implant failure in hip arthroplasty. Clinical studies have reported that support beneath a Burch-Schneider cage has a large effect on the implant survival rate [6,8,9,10]. This study investigated if the effect of Burch-Schneider cage support on the implant and bone stresses can be demonstrated by means of finite element analysis.…”

“…Lamo-Espinosa et al [5] showed a 79% survival rate at 10 years after implantation in 16 hips. The study of Hsu et al [6] indicated a 5-year survival rate of 76% in 31 cage reconstructions. However, these studies do not separately report results for defects of different Paprosky classification [7].…”

“…To improve cage stability in large and uncontained bone defects, surgeons may use a defect-filling structure that provides additional support to a Burch-Schneider cage. Structural allografts are commonly used in defects with severely degraded acetabular bone stock [6,11,12,13]. A disadvantage of allografts is the complex surgical procedure they require to shape and fit the allograft to the bone defect.…”

Titanium cage reconstruction of acetabular defects in revision hip arthroplasty results in favourable outcomes: up to 17 years follow-up

“…In favourable conditions, viable bone tissue has been demonstrated to grow on titanium surfaces thus eventually providing a durable support for the cage. [1][2][3][4][5][6] Modern trabecular metal systems provide versatility trough modular options with better osteoconductivity in order to maintain a stable bone-prosthesis interface, however, these implants come with higher costs and they may not be available in some areas or health systems. Although the initial studies have been reported high success rates in acetabular reconstruction with tantalum cages and attributing their superior biologic fixation properties, subsequent long-term follow-up showed less favourable outcomes.…”