scholarly journals Acetabular Reconstruction with the Burch-Schneider Antiprotrusio Cage and Bulk Allografts: Minimum 10-Year Follow-Up Results

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Dario Regis ◽  
Andrea Sandri ◽  
Ingrid Bonetti
Keyword(s):  
Bone Loss ◽  
Survival Rates ◽  
Harris Hip Score ◽  
Pelvic Bone ◽  
Acetabular Reconstruction ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Additional Surgery ◽  
Acetabular Bone Defects

Reconstruction of severe pelvic bone loss is a challenging problem in hip revision surgery. Between January 1992 and December 2000, 97 hips with periprosthetic osteolysis underwent acetabular revision using bulk allografts and the Burch-Schneider antiprotrusio cage (APC). Twenty-nine patients (32 implants) died for unrelated causes without additional surgery. Sixty-five hips were available for clinical and radiographic assessment at an average follow-up of 14.6 years (range, 10.0 to 18.9 years). There were 16 male and 49 female patients, aged from 29 to 83 (median, 60 years), with Paprosky IIIA (27 cases) and IIIB (38 cases) acetabular bone defects. Nine cages required rerevision because of infection (3), aseptic loosening (5), and flange breakage (1). The average Harris hip score improved from 33.1 points preoperatively to 75.6 points at follow-up (P<0.001). Radiographically, graft incorporation and cage stability were detected in 48 and 52 hips, respectively. The cumulative survival rates at 18.9 years with removal for any reason or X-ray migration of the cage and aseptic or radiographic loosening as the end points were 80.0% and 84.6%, respectively. The use of the Burch-Schneider APC and massive allografts is an effective technique for the reconstructive treatment of extensive acetabular bone loss with long-lasting survival.

Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity

2018 ◽  
Vol 100-B (11) ◽  
pp. 1442-1448 ◽  
Author(s):  
C. Hipfl ◽  
V. Janz ◽  
J. Löchel ◽  
C. Perka ◽  
G. I. Wassilew
Keyword(s):  
Bone Loss ◽  
Revision Surgery ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Postoperative Function ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Acetabular Bone Loss ◽  
The Mean

AimsSevere acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems.Patients and MethodsWe undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015. The mean age at the time of surgery was 70 years (42 to 85) and all patients had an acetabular defect graded as Paprosky Type 2C through to 3B, with 24 hips (69%) having PD. The mean follow-up was 47 months (25 to 84).ResultsThe cumulative five-year survivorship of the implant with revision for any cause was 89% (95% confidence interval (CI) 72 to 96) with eight hips at risk. No revision was required for aseptic loosening; however, one patient with one hip (3%) required removal of the ischial flange of the cage due to sciatic nerve irritation. Two patients (6%; two hips) suffered from hip dislocation, whereas one patient (one hip) required revision surgery with cement fixation of a dual-mobility acetababular component into a well-fixed cup-cage construct. Two patients (6%; two hips) developed periprosthetic infection. One patient was successfully controlled with a two-stage revision surgery, while the other patient underwent excision arthroplasty due to severe medical comorbidities. For the whole series, the Harris Hip Score significantly improved from a mean of 30 (15 to 51) preoperatively to 71 (40 to 89) at the latest follow-up (p < 0.001).ConclusionOur findings suggest that cup-cage reconstruction is a viable option for major segmental bone defects involving the posterior column and PD. It allows adequate restoration of the acetabulum centre with generally good stability and satisfactory postoperative function. Instability and infection remain drawbacks in these challenging revision cases. Cite this article: Bone Joint J 2018;100-B:1442–48.

Acetabular impaction grafting with mesh for acetabular bone defects: a systematic review

2020 ◽  
pp. 112070002097185
Author(s):  
Michael-Alexander Malahias ◽  
Fabio Mancino ◽  
Alex Gu ◽  
Marco Adriani ◽  
Ivan De Martino ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Grafting ◽  
Survival Rates ◽  
Bone Defects ◽  
Reoperation Rate ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Cochrane Database ◽  
Acetabular Bone Defects

Introduction: In conjunction with impaction bone grafting (IBG), metal meshes have been proposed to minimise defects of the medial and superolateral walls in order to convert combined complex uncontained segmental defects into contained cavitary defects to facilitate IBG. Methods: The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to March 2019 utilising keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting, clinical or functional outcomes, revision THA, or postoperative complications. Results: 7 articles were found to be suitable for inclusion in the present study. The mean modified Coleman methodology score for methodological deficiencies of the studies was 45.3 (range 38–59). Severe acetabular bone loss was present in 56% of cases having moderate bone loss in 18%, and mild in 26%. The all-cause reoperation rate was 7.4%, while the all-cause revision rate of the acetabular component was 6.2%. Conclusions: IBG with mesh is effective for selected patients with acetabular bone defects. Most patients with moderate bone loss as well as selected patients with large superolateral defects can be successfully treated with IBG combined with mesh. There is limited data to show that IBG with mesh might be associated with decreased survival rates in patients with severe lateral defects (Paprosky IIIA) combined with ischial or medial wall osteolysis who require combined medial and lateral meshes. In addition, patients with severe superomedial migration of the cup (Paprosky IIIB) should not be treated with IBG and mesh.

scholarly journals Mid-term result of acetabular reconstruction using a Kerboull-type acetabular reinforcement device with hydroxyapatite impaction

2020 ◽  
pp. 221049172097183
Author(s):  
Hidetatsu Tanaka ◽  
Daisuke Chiba ◽  
Norikazu Yamada ◽  
Masahiko Tanaka ◽  
Yoshiyuki Kuwahara ◽  
...  
Keyword(s):  
Survival Rates ◽  
Acetabular Reconstruction ◽  
Type Ii ◽  
Term Result ◽  
Acetabular Bone ◽  
Kaplan Meier ◽  
Acetabular Bone Defects ◽  
The Mean ◽  
Mid Term Results ◽  
Reinforcement Device

The aim of this study is to investigate the mid-term results of 29 hips in 26 patients who underwent acetabular reconstruction using a Kerboull-type acetabular reinforcement device and impaction with hydroxyapatite (HA) granules. The acetabular bone defects were AAOS type II for six hips and type III for 23 hips. The mean Merle d’Aubigné clinical scores were significantly improved after operation. Six hips developed implant migration and breakage, and five of six hips were revised after an average of 5.5 (range 2.0–8.8) years. All hips with thickness of the grafted HA less than 10 mm were stable. As the HA became thicker, the failure rate were significantly increased. The Kaplan–Meier survival rates at 10 years were 73.2%, with 100% and 67.0% for AAOS type II and III defect respectively as the end point was failure condition. Reconstruction using a Kerboull-type acetabular reinforcement device and impaction with HA granules was an alternative method in the absence of adequate allografts.

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

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 66-72 ◽  
Author(s):  
Mattia Loppini ◽  
Paolo Schiavi ◽  
Antonello Della Rocca ◽  
Francesco Traverso ◽  
Federico Della Rocca ◽  
...  
Keyword(s):  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Trabecular Metal ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Type Iii ◽  
Heterotopic Ossifications ◽  
Radiographic Outcomes ◽  
Acetabular Bone Defects

Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.

Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes

2018 ◽  
Vol 69 (8) ◽  
pp. 2217-2221
Author(s):  
Stefan Mogos ◽  
George Viscopoleanu ◽  
Monica Dascalu ◽  
Radu Orfanu
Keyword(s):  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Management Options ◽  
Acetabular Bone ◽  
Type Iiia ◽  
Acetabular Bone Defects ◽  
The Mean ◽  
Acetabular Defects

The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.

scholarly journals Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 64-71
Author(s):  
Frank S Fröschen ◽  
Thomas M Randau ◽  
Gunnar T R Hischebeth ◽  
Nadine Gravius ◽  
Dieter C Wirtz ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Treatment Success ◽  
Case Series ◽  
Successful Outcome ◽  
Harris Hip Score ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Multi Stage ◽  
Custom Made

Background: Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a “second” rTHA with “custom-made acetabular components (CMACs)” after a previously failed reconstruction with CMACs. Methods: 4 patients with severe acetabular bone loss (Paprosky Type IIIB), who required a second rTHA after a previously failed reconstruction with CMAC, due to prosthetic joint infection (PJI), were included in our retrospective study. All prostheses had been constructed on the basis of thin-layer computed-tomography scans of the pelvis. The second rTHA was considered unsuccessful in the event of PJI or aseptic loosening (AL) with need for renewed CMAC explantation. Results: The treatment success rate after second rTHA with a CMAC was 50% (2 of 4). In the successful cases, the visual analogue scale (VAS) score and Harris Hip Score (HHS) after the second rTHA (VAS range 2–4; HHS range 45–58 points) did not differ from those after the first rTHA, before onset of symptoms (VAS: range 2–4; HHS: range 47–55 points). In the failed cases, the second CMACs needed to be explanted due to PJI, with renewed detection of previous pathogens. Patients with treatment failure of the second CMAC had required a higher number of revision surgeries after explantation of the first CMAC than patients with a successful outcome. Conclusions: In patients with severe acetabular bone loss and previously failed rTHA with CMACs, repeat rTHA with a CMAC may be a solid treatment option for patients with an “uncomplicated” multi-stage procedure, i.e., without persisting infection after explantation of the original CMAC. While the outcome in terms of clinical function does not appear negatively affected by such a “second attempt,” the complication rate and risk of reinfection, nonetheless, is high.

scholarly journals Cup-on-cup technique: a reliable management solution for severe acetabular bone loss in revision total hip replacement

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 12-18
Author(s):  
Francesco Chiarlone ◽  
Luca Cavagnaro ◽  
Andrea Zanirato ◽  
Mattia Alessio Mazzola ◽  
Stefano Lovisolo ◽  
...  
Keyword(s):  
Bone Loss ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Leg Length ◽  
Short Term ◽  
Acetabular Bone ◽  
Length Discrepancy ◽  
Acetabular Bone Loss ◽  
Centre Of Rotation

Background: The management of acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). The goals of treatment are a stable acetabular fixation, implant stability, and restoration of hip centre of rotation. This study aims to report clinical, radiological outcomes and complications at short-term to mid-term follow-up of the cup-on-cup technique in the management of severe acetabular bone loss in rTHA. Methods: We retrospectively reviewed the records of patient receiving rTHA performed with double porous tantalum cup technique in a single Joint Replacement Unit from 2014 to 2017. Objective and subjective clinical scores (Harris Hip Score, Oxford Hip Score, and visual analogue scale), radiological parameters (centre of rotation, leg-length discrepancy, heterotopic ossification, osseointegration, loosening and radiolucencies) and complications were recorded. We analysed the implant survival rate and periprosthetic joint infection rate. Results: We included 9 patients (9 hips) with a mean follow-up of 35.3 ± 10.8 months. Functional scores showed a statistically significant improvement at the final follow-up ( p < 0.01). All patients rated their surgery as satisfactory. The cup-on-cup construct demonstrated radiological osseointegration with the centre of rotation restoration and leg length discrepancy improvement. In 1 patient, periprosthetic joint infection was diagnosed and treated with suppressive antibiotic therapy. No patients underwent acetabular components revision surgery for any reason. Conclusions: Cup-on-cup technique is a valid and safe solution for reconstruction of selected Paprosky type IIIA and IIIB bone defects with satisfactory clinical and radiographic results at short-term and mid-term follow-up.

Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity

2021 ◽  
pp. 1-9
Author(s):  
Frank S. Fröschen ◽  
Thomas M. Randau ◽  
Nadine Gravius ◽  
Dieter C. Wirtz ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Treatment Failure ◽  
Implant Failure ◽  
Rheumatoid Disease ◽  
Acetabular Bone ◽  
Pelvic Discontinuity ◽  
Acetabular Bone Loss ◽  
Custom Made

BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5–120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.

scholarly journals Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty

2020 ◽  
Author(s):  
Fabio Mancino ◽  
Giorgio Cacciola ◽  
Davide De Marco ◽  
Alexander Greenberg ◽  
Carlo Perisano ◽  
...  
Keyword(s):  
Bone Loss ◽  
Hip Arthroplasty ◽  
Bone Defects ◽  
Acetabular Reconstruction ◽  
Metal Mesh ◽  
Acetabular Bone ◽  
Acetabular Bone Loss ◽  
Custom Made ◽  
Long Term Studies

Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large “jumbo cups”, oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.

Major Acetabular Defects Treated with the Burch-Schneider Antiprotrusion Cage and Impaction Bone Allograft in a Large Series: A 5- to 7- Year Follow-up Study

2016 ◽  
Vol 26 (6) ◽  
pp. 585-590 ◽  
Author(s):  
Axel Marx ◽  
Alexander Beier ◽  
Anne Richter ◽  
Christoph H. Lohmann ◽  
Andreas M. Halder
Keyword(s):  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Allograft ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Hip Revision ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Introduction Major bone defects are the greatest challenge in hip revision arthroplasty. Methods In a prospective, consecutive nonrandomised study we followed up 74 patients with Type III (AAOS) acetabular bone defects who underwent revision hip arthroplasty with bone grafting and implantation of a Burch-Schneider anti-protrusion cage (APC). The patients were examined pre- and postoperatively according to a standardised clinical and radiological protocol. No patient was lost to follow-up. Results 9 patients died before follow-up. In 9 other patients the APC was revised within the follow-up period. In 4 of these patients the revision was necessary because of aseptic loosening. In the remaining 5 cases joint infection, recurrent dislocation and 1 trauma were the reasons for revision. 56 patients were included in the statistical analysis. In the follow-up group the mean Harris Hip Score increased from 39.9 preoperatively to 73.2. 85% of the patients assessed their operation result as good or excellent. Conclusions In a large consecutive series the Burch-Schneider anti-protrusion cage proved to be a valuable option in the treatment of major acetabular bone defects in hip revision surgery.

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