scholarly journals Custom Made Monoflange Acetabular Components for the Treatment of Paprosky Type III Defects

2021 ◽  
Vol 11 (4) ◽  
pp. 283
Author(s):  
Sebastian Philipp von Hertzberg-Boelch ◽  
Mike Wagenbrenner ◽  
Jörg Arnholdt ◽  
Stephan Frenzel ◽  
Boris Michael Holzapfel ◽  
...  
Keyword(s):  
Hip Joint ◽  
Successful Outcome ◽  
Patient Specific ◽  
Center Of Rotation ◽  
Type Iii ◽  
Joint Reconstruction ◽  
Acetabular Bone Loss ◽  
Custom Made ◽  
Revision Tha ◽  
Acetabular Components

Purpose: Patient-specific, flanged acetabular components are used for the treatment of Paprosky type III defects during revision total hip arthroplasty (THA). This monocentric retrospective cohort study analyzes the outcome of patients treated with custom made monoflanged acetabular components (CMACs) with intra- and extramedullary iliac fixation. Methods: 14 patients were included who underwent revision THA with CMACs for the treatment of Paprosky type III defects. Mechanism of THA failure was infection in 4 and aseptic loosening in 10 patients. Seven patients underwent no previous revision, the other seven patients underwent three or more previous revisions. Results: At a mean follow-up of 35.4 months (14–94), the revision rate of the implant was 28.3%. Additionally, one perioperative dislocation and one superficial wound infection occurred. At one year postoperatively, we found a significant improvement of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score (p = 0.015). Postoperative radiographic analysis revealed good hip joint reconstruction with a mean leg length discrepancy of 3 mm (−8–20), a mean lateralization of the horizontal hip center of rotation of 8 mm (−8–35), and a mean proximalization of the vertical hip center of rotation of 6 mm (13–26). Radiolucency lines were present in 30%. Conclusion: CMACs can be considered an option for the treatment of acetabular bone loss in revision THA. Iliac intra- and extramedullary fixation allows soft tissue-adjusted hip joint reconstruction and improves hip function. However, failure rates are high, with periprosthetic infection being the main threat to successful outcome.

Preliminary results of a 3D-printed acetabular component in the management of extensive defects

2017 ◽  
Vol 28 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Mustafa Citak ◽  
Lilly Kochsiek ◽  
Thorsten Gehrke ◽  
Carl Haasper ◽  
Eduardo M Suero ◽  
...  
Keyword(s):  
Bone Loss ◽  
Acetabular Component ◽  
Complication Rate ◽  
Primary Outcome Measure ◽  
Patient Specific ◽  
Component Technique ◽  
Revision Tha ◽  
3D Printed ◽  
Acetabular Defects ◽  
Acetabular Components

Introduction: The treatment of extensive bone loss and massive acetabular defects can be compounded by several challenges and pitfalls. The survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The goal of the present study was to analyse the outcomes of 3D-printed patient-specific acetabular components in the management of extensive acetabular defects and combined pelvic discontinuity (PD). Methods: 9 patients underwent revision THA using 3D-printed custom acetabular components to reconstruct extensive acetabular defects. The Paprosky classifications were determined in all patients. The primary outcome measure was the implant-associated failure rate. Results: 1 out of 9 patients suffered an implant-associated complication (11%). The overall implant-associated survival rate was 89%. The overall complication rate was 56%. Conclusions: The patient-specific acetabular component technique shows promise for the treatment of patients with severe acetabular defects in revision THA. Further research aimed at reducing costs and improving the complication rate are warranted.

scholarly journals Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results

2020 ◽  
Author(s):  
Michael Stephan Gruber ◽  
Michael Jesenko ◽  
Julia Burghuber ◽  
Josef Hochreiter ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Special Treatment ◽  
Center Of Rotation ◽  
Custom Made ◽  
Significant Difference ◽  
Oxford Hip Score ◽  
Acetabular Defects ◽  
Type 3 ◽  
Acetabular Components

Abstract Background Severe acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects.Methods Sixteen patients were eligible for this trial, nine of whom agreed to be included. All of them completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics.Results The mean follow-up time of the nine patients was 12.2 months (range: 10 - 18). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed restoration of the height of the center of rotation and of the global offset. Significant difference was detected in the femoral offset.Conclusions The functional and radiological outcomes are promising. However, long-term outcomes still need to be examined.Level of Evidence: Therapeutic Level IV.

scholarly journals Functional and radiological outcomes after treatment with custom-made acetabular components in patients with Paprosky type 3 acetabular defects: short-term results

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael S. Gruber ◽  
Michael Jesenko ◽  
Julia Burghuber ◽  
Josef Hochreiter ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Harris Hip Score ◽  
Special Treatment ◽  
Center Of Rotation ◽  
Custom Made ◽  
Significant Difference ◽  
Oxford Hip Score ◽  
Acetabular Defects ◽  
Type 3 ◽  
Acetabular Components

Abstract Background Severe acetabular defects require special treatment with either impaction bone grafting, metal augmented cups or cup-cage constructs. Even these options are often not adequate, especially in hips with Paprosky type 3 defects with loss of anterior and posterior columns. This study investigates the clinical and radiological outcomes of custom-made acetabular components (© Materialise NV, Leuven, Belgium) for Paprosky type 3 defects. Methods Sixteen patients were eligible for this trial, nine of whom agreed to be included. All of them completed one year of follow-up. The Harris hip score and the Oxford hip score were used to compare pre- and postoperative functional outcomes. Radiological follow-up comprised anteversion and inclination of the implanted cup and offset measurements in both hips (femoral, medial, ischial offset and center of rotation). Statistical analyses were performed with IBM SPSS Statistics. Results The mean follow-up time of the nine patients was 12.2 months (range: 10–18). The Oxford hip score and Harris hip score improved from 19.8 and 50.1 to 29.4 and 68.8, respectively (p = 0.009 and 0.01). There were complications in three cases (33.3%), which led to one re-revision (11.1%). Radiologic follow-up showed restoration of the height of the center of rotation and of the global offset. Significant difference was detected in the femoral offset. Conclusions The functional and radiological outcomes are promising. However, long-term outcomes still need to be examined. Level of evidence Therapeutic Level IV.

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.

Early Survival of Two High-Porosity Acetabular Components after Total Hip Arthroplasty Revision

2017 ◽  
Vol 01 (02) ◽  
pp. 069-073
Author(s):  
Karim Elsharkawy ◽  
Mike Hadley ◽  
Bishoy Gad ◽  
Joseph Styron ◽  
Carlos Higuera ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Average Length ◽  
High Porosity ◽  
Acetabular Bone ◽  
Total Hip ◽  
Acetabular Bone Loss ◽  
Revision Tha ◽  
Acetabular Components

AbstractTotal hip arthroplasty (THA) revision rates remain high and are expected to increase. Different ingrowth surfaces including tantalum and titanium have been introduced to improve fixation and survival. Promising results have been shown with tantalum. This study was conducted to compare the survivorship of titanium and tantalum components after revision THA. A retrospective review of all THA revision cases from January 2002 to December 2010 was performed. Cases, where the questioned components were used, were enlisted in a single continuous cohort. A minimum of 2-year follow-up was required for inclusion. Patients were compared in two groups: titanium versus tantalum components, with the endpoint defined as any failure requiring acetabular component removal. A total of 118 patients were analyzed and included 64 patients in the tantalum group and 56 patients in the titanium group. The average length of follow-up was 50.4 months for both groups. Cases, where tantalum implants were used, were more likely to have a worse acetabular bone loss (p = 0.005). The main cause of index revision was aseptic loosening followed by infection. At the latest follow-up, survivorship was very similar in appearance and failed to achieve statistical difference (log-rank p = 0.1146). Among the variables assessed as potential predictors of failure, only the number of prior revisions was statistically significant (p = 0.004). The high-porosity titanium acetabular components demonstrate same survivorship at 2-year follow-up as the tantalum cups in the setting of revision THA. Only the number of prior revisions was significantly associated with increased failure rate.

scholarly journals Indwelling Device-Associated Biofilms in Critically Ill Cancer Patients—Study Protocol

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 306
Author(s):  
Olguta Lungu ◽  
Ioana Grigoras ◽  
Olivia Simona Dorneanu ◽  
Catalina Lunca ◽  
Teodora Vremera ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Critically Ill ◽  
Pathogen Detection ◽  
Venous Catheter ◽  
Successful Outcome ◽  
Patient Specific ◽  
Clinical Value ◽  
Current Standard ◽  
Sepsis Management ◽  
Microorganism Identification

Health care-associated infections are a leading cause of inpatient complications. Rapid pathogen detection/identification is a major challenge in sepsis management that highly influences the successful outcome. The current standard of microorganism identification relies on bacterial growth in culture, which has several limitations. Gene sequencing research has developed culture-independent techniques for microorganism identification, with the aim to improve etiological diagnosis and, therefore, to change sepsis outcome. A prospective, observational, non-interventional, single-center study was designed that assesses biofilm-associated pathogens in a specific subpopulation of septic critically ill cancer patients. Indwelling device samples will be collected in septic patients at the moment of the removal of the arterial catheter, central venous catheter, endotracheal tube and urinary catheter. Concomitantly, clinical data regarding 4 sites (nasal, pharyngeal, rectal and skin) of pathogen colonization at the time of hospital/intensive care admission will be collected. The present study aims to offer new insights into biofilm-associated infections and to evaluate the infection caused by catheter-specific and patient-specific biofilm-associated pathogens in association with the extent of colonization. The analysis relies on the two following detection/identification techniques: standard microbiological method and next generation sequencing (NGS). Retrospectively, the study will estimate the clinical value of the NGS-based detection and its virtual potential in changing patient management and outcome, notably in the subjects with missing sepsis source or lack of response to anti-infective treatment.

scholarly journals An Innovative and Cost-Advantage CAD Solution for Cubitus Varus Surgical Planning in Children

2021 ◽  
Vol 11 (9) ◽  
pp. 4057
Author(s):  
Leonardo Frizziero ◽  
Gian Maria Santi ◽  
Christian Leon-Cardenas ◽  
Giampiero Donnici ◽  
Alfredo Liverani ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Low Cost ◽  
Cost Effective ◽  
Varus Deformity ◽  
Patient Specific ◽  
Cubitus Varus ◽  
Surgical Guide ◽  
Traditional Procedure ◽  
Custom Made ◽  
Patient Specific Instruments

The study of CAD (computer aided design) modeling, design and manufacturing techniques has undergone a rapid growth over the past decades. In medicine, this development mainly concerned the dental and maxillofacial sectors. Significant progress has also been made in orthopedics with pre-operative CAD simulations, printing of bone models and production of patient-specific instruments. However, the traditional procedure that formulates the surgical plan based exclusively on two-dimensional images and interventions performed without the aid of specific instruments for the patient and is currently the most used surgical technique. The production of custom-made tools for the patient, in fact, is often expensive and its use is limited to a few hospitals. The purpose of this study is to show an innovative and cost-effective procedure aimed at prototyping a custom-made surgical guide for address the cubitus varus deformity on a pediatric patient. The cutting guides were obtained through an additive manufacturing process that starts from the 3D digital model of the patient’s bone and allows to design specific models using Creo Parametric. The result is a tool that adheres perfectly to the patient’s bone and guides the surgeon during the osteotomy procedure. The low cost of the methodology described makes it worth noticing by any health institution.

scholarly journals Early Outcomes of Patient-Specific Modular Cones for Substitution of Methaphysial and Diaphysial Bone Defects in Revision Knee Arthroplasty

2019 ◽  
Vol 25 (2) ◽  
pp. 9-18 ◽  
Author(s):  
A. A. Cherny ◽  
A. N. Kovalenko ◽  
S. S. Bilyk ◽  
A. O. Denisov ◽  
A. V. Kazemirskiy ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Scoring Systems ◽  
Bone Defects ◽  
Patient Specific ◽  
Implant Fixation ◽  
Diaphyseal Bone ◽  
Custom Made ◽  
The Stability ◽  
Valid Solution

The aim of this study was the assessment of early outcomes of patient-specific three-dimensional titanium cones with specified porosity parameters to compensate for extensive metaphysical-diaphyseal bone defects in RTKA.Materials and Methods. Since 2017 till 2019 30 patient-specific titanium cones (12 femoral and 18 tibial) implanted during 26 RTKAS. Clinical outcomes evaluated using KSS, WOMAC and fjS-12 scoring systems on average 10 (2–18) months after surgery. At the same time the stability of implant fixation analyzed using frontal, lateral and axial knee roentgenograms.Results. During all procedures there were no technical difficulties in positioning and implantation of custom-made titanium cones. At the time of preparation of the publication, none of the patients had indications for further surgical intervention, as well as intra- and postoperative complications. Six months after surgery all scores improved significantly: KSS from 23 (2–42, SD 19.96) to 66.5 (62–78, SD 7.68), WOMAC from 59 (56–96, SD 28.31) to 32.25 (19–46, SD 11.76), the index FJS-12 was 29.16 points (0–68.75, SD 30.19). The average scores continued to improve up to 18 months: KSS — 97.5 (88–108, SD 9.14), WOMAC — 16.5 (9–24, SD 6.45), FJS-12 — 45.85 (25–75, SD 22.03). No radiolucent lines were noticed during this period of observation.Conclusion. The original additive technology of designing and producing patient-specific titanium cones for compensation of extensive metaphyseal-diaphyseal bone defects in RTKA is a valid solution at least in the short term. A longer follow-up period is required to assess its medium-and long-term reliability compared to existing alternative surgical solutions.

scholarly journals Innovative Design Methodology for Patient-Specific Short Femoral Stems

Materials ◽  
2022 ◽  
Vol 15 (2) ◽  
pp. 442
Author(s):  
William Solórzano-Requejo ◽  
Carlos Ojeda ◽  
Andrés Díaz Lantada
Keyword(s):  
Computer Aided Design ◽  
Design Methodology ◽  
Patient Specific ◽  
Bone Stock ◽  
Innovative Design ◽  
Hip Prostheses ◽  
Custom Made ◽  
In Silico Studies ◽  
Femoral Stems ◽  
Short Stems

The biomechanical performance of hip prostheses is often suboptimal, which leads to problems such as strain shielding, bone resorption and implant loosening, affecting the long-term viability of these implants for articular repair. Different studies have highlighted the interest of short stems for preserving bone stock and minimizing shielding, hence providing an alternative to conventional hip prostheses with long stems. Such short stems are especially valuable for younger patients, as they may require additional surgical interventions and replacements in the future, for which the preservation of bone stock is fundamental. Arguably, enhanced results may be achieved by combining the benefits of short stems with the possibilities of personalization, which are now empowered by a wise combination of medical images, computer-aided design and engineering resources and automated manufacturing tools. In this study, an innovative design methodology for custom-made short femoral stems is presented. The design process is enhanced through a novel app employing elliptical adjustment for the quasi-automated CAD modeling of personalized short femoral stems. The proposed methodology is validated by completely developing two personalized short femoral stems, which are evaluated by combining in silico studies (finite element method (FEM) simulations), for quantifying their biomechanical performance, and rapid prototyping, for evaluating implantability.

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