scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Long Term Prognosis ◽  
Postoperative Dislocation ◽  
Component Loosening

Abstract Background: The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods: This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum follow-up of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results: At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occurred. Conclusions: Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity, with encouraging results at early-term. However, ongoing follow-up is required to determine the long-term prognosis in patients receiving this technique.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Postoperative Dislocation ◽  
Component Loosening ◽  
Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

scholarly journals Reverse reaming distraction for acetabular reconstruction of chronic pelvic discontinuity

2020 ◽  
Author(s):  
Jing-yang Sun ◽  
Ming Ni ◽  
Hai-yang Ma ◽  
Yin-qiao Du ◽  
Jun-min Shen ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Vertical Direction ◽  
Porous Metal ◽  
Harris Hip Score ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Postoperative Dislocation ◽  
Component Loosening ◽  
Minimum Followup

Abstract Introduction The acetabular distraction technique demonstrates encouraging radiographic and clinical outcomes in treating chronic pelvic discontinuity. The aim of this study is to describe a modified distraction technique and to show our results. Methods This study identified 12 cases of chronic pelvic discontinuity undergoing primary or revision total hip arthroplasty (THA) with the technique of reverse reaming distraction between July 2015 and November 2018. All 12 patients had a minimum followup of 12 months. Radiographs were reviewed to inspect for component loosening. Clinical assessment included the Harris hip score (HHS) and an ambulatory scoring system. Results At the time of final follow-up, no patient was revised. One patient had up to 1 cm migration of the cup in a horizontal or vertical direction and more than 20° change in the abduction angle but was asymptomatic. In the remaining 11 patients, no migration of the component was detected. Both the HHS and ambulatory score showed improvement in all patients. There were no perioperative complications. No postoperative dislocation occured. Conclusions Reverse reaming distraction is a feasible technique in treatment of chronic pelvic discontinuity. Sometimes it can work with the aid of augment or cup-cage construct. When both the superior and inferior portions of the pelvis achieve osteointegration into the porous metal cup, a long-term durability can be expected.

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.

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.

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.

scholarly journals Extended Ischiopubic Fixation Using Porous Metal Augments In Cementless Acetabular Reconstruction During Revision Total Hip Arthroplasty

2020 ◽  
Author(s):  
Yong Huang ◽  
Yixin Zhou ◽  
Hongyi Shao ◽  
Hao Tang ◽  
Dejin Yang ◽  
...  
Keyword(s):  
Primary Stability ◽  
Porous Metal ◽  
Clinical Results ◽  
Fracture Dislocation ◽  
Harris Hip Score ◽  
Acetabular Reconstruction ◽  
Horizontal Distance ◽  
Stable Fixation ◽  
Center Of Rotation

Abstract Background: As opposed to rim fixation, 3-point fixation provides sufficient primary stability for cememless cups in the presence of massive bony deficiency. While several methods, including doming augments or flying buttress augments, have been introduced to reconstruct superior supportive points, good methods to establish supportive ischiopubic points are currently lacking. The aims of this study were to introduce the definition, indication and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical and radiographic results and complications of hips revised with EIF.Methods: Patients who underwent revision THA utilizing the technique of EIF with porous metal augments secured in the ischium and/or pubis in a single institution from February 2015 to February 2020 were retrospectively reviewed. 25 patients were included based on the criteria of minimum 2-year follow-up. The median duration of follow-up was 48.06 months (interquartile range: 41.37-62.20 months). The patients’ clinical results were assessed using of the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis index and any complications including infection, intraoperative fracture, dislocation, postoperative nerve palsy, hematoma, wound complication and/or any subsequent reoperation(s) were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation and cup orientoration. Results: At the most recent follow-up, 20 (80%) patients rated their satisfaction level as “very satisfied”, 5 (20%) were “satisfied”. The median HHS score improved from 36.00 preoperatively to 81.00 (p＜0.001) while the median WOMAC index score decreased from 74.50 preoperatively to 16.50 at the latest follow-up (p＜0.001). No intraoperative or postoperative complications were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative center of rotation to the anatomic center of rotation improved from 13.62 mm and 8.68 mm preoperatively to 4.42 mm and 4.19 mm, at final follow-up (p<0.001), respectively.Conclusions: Early follow-up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation and restoration of the center of rotation.

scholarly journals Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities

2019 ◽  
Vol 6 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Adam I Edelstein ◽  
Stephen T Duncan ◽  
Sean Akers ◽  
Gail Pashos ◽  
Perry L Schoenecker ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Periacetabular Osteotomy ◽  
Hip Dislocation ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Surgical Hip Dislocation ◽  
Level Of Evidence ◽  
Permanent Disability ◽  
Superior Pubic Ramus

AbstractSurgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications. Forty-five patients (46 hips) were identified. Perioperative complications were graded by the modified Clindo-Davien complication scheme. Mean follow-up was 36 months (range 12–128), and no patients were lost to follow-up. Six complications occurred in six hips (13%). Four (8.7%) complications were minor (Grades I or II): one Brooker Grade III heterotopic ossification requiring no treatment, one superior pubic ramus nonunion requiring no treatment and two superficial wound infections requiring antibiotics. Two (4.3%) complications were major (Grades III or IV): one coxa saltans interna and labral tear requiring hip arthroscopy with labral repair and iliopsoas lengthening, and one deep surgical site infection requiring irrigation and debridement followed by development of arthritis requiring conversion to arthroplasty. The average Harris hip score improved from 62 ± 13 preoperatively to 80 ± 19 at final follow-up. Except for the single joint replacement, there were no long-term disabilities. There were no major neurovascular injuries, osteonecrosis, fractures or trochanteric nonunions. Combined SD/PAO for the treatment of complex, concomitant deformities of the proximal femur and acetabulum is associated with an acceptable risk of complications. The vast majority of complications that occurred were managed without permanent disability.Level of Evidence: IV

scholarly journals Bone Impaction Grafting with Trabecular Metal Augments in Large Defects in Young Patients: Unravelling A New Perspective in Surgical Technique

2020 ◽  
Author(s):  
Basilio De la Torre-Escurero ◽  
Eva Gómez-González ◽  
Slavador Álvarez-Villar ◽  
Julia Bujan ◽  
Miguel A Ortega
Keyword(s):  
Surgical Technique ◽  
Young Patients ◽  
Case Series ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Impaction Grafting ◽  
Trabecular Metal ◽  
Bone Impaction Grafting ◽  
Acetabular Defects

Abstract Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.

Mid-term follow-up after all-size acetabular revision and proposal for a stability classification system

2019 ◽  
Vol 30 (4) ◽  
pp. 431-437 ◽  
Author(s):  
Sebastian G Walter ◽  
Tom S Thomas ◽  
Daniel Kenndoff ◽  
Wolfram Thomas
Keyword(s):  
Harris Hip Score ◽  
Acetabular Reconstruction ◽  
Acetabular Defect ◽  
Observer Reliability ◽  
Reconstruction Methods ◽  
Stability Classification ◽  
Biological Solutions ◽  
Mid Term Results ◽  
Arthroplasty Revision

Background: There is a trend for using jumbo cups/oblong devices for acetabular reconstruction as alternative to biological solutions. We report about a spectrum of reconstruction methods and their mid-term results. Methods: Inclusion of 214 consecutive patients undergoing total hip arthroplasty revision surgery. Patients were examined using the Harris Hip Score (HHS). Based on the intraoperative acetabular defect situation, cases were classified into 1 of 5 possible categories of a stability classification for acetabular replacement (SCAR). Results: Mean HHS improved from 42 preoperatively (range 12–62) to 77 (range 54–90; p < 0.05) 6 months after operation. There were significant differences of the pre-and postoperative HHS between SCAR subgroups ( p < 0.05). Inter-observer reliability of the SCAR was high (kappa 0.94 (95% CI, 0.90–0.98)). Re-revision was performed in 15 cases (7%). Conclusion: The SCAR classification is a practicable tool for intraoperative decision-making as it provides standardised treatment recommendations.

Early Results of a New Highly Porous Modular Acetabular Cup in Revision Arthroplasty

2009 ◽  
Vol 19 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Manjunath Ramappa ◽  
Ali Bajwa ◽  
Ashwin Kulkarni ◽  
Ian Mcmurtry ◽  
Andrew Port
Keyword(s):  
Revision Arthroplasty ◽  
Harris Hip Score ◽  
Acetabular Cup ◽  
Pelvic Discontinuity ◽  
Early Results ◽  
A Prospective Study ◽  
Type 3 ◽  
Highly Porous

Background The ‘Tritanium’® (Stryker, New Jersey, USA) highly porous acetabular cup is a new implant used in revision hip arthroplasty. Aim To determine the early results of this device. Methods A prospective study of 43 acetabular component revisions performed using the implant between March 2007 and February 2008 was undertaken. All procedures were performed at a single centre with standard approach and follow up. Results The mean age of patients at surgery was 66 years. Mean follow up was 18.2 months. AAOS classification revealed 17% type 1, 49% type 2, 24% Type 3 and 5% Type 4 defects at surgery. 5% had no bone defect. Bone graft was used to in 73% of patients. Mean Harris Hip Score improved from 68 pre-operatively to 86 at the last follow-up. Cup integration was seen in 95% of patients by 6 weeks. One patient with pelvic discontinuity had symptomatic aseptic loosening which was revised. Conclusion The ‘Tritanium'acetabular cup has been successful in achieving rapid osseointegration with few complications. The management of pelvic discontinuity continues to be a challenge.

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