L5 Radiculopathy Secondary to Migration of a Revision Stemmed Acetabular Cup

2017 ◽  
Vol 27 (5) ◽  
pp. e7-e10
Author(s):  
Jesús Moreta ◽  
Oscar L. Casado-Verdugo ◽  
Fernando Labayru
Keyword(s):  
Facet Joint ◽  
Acetabular Reconstruction ◽  
Complication Rates ◽  
Acetabular Cup ◽  
Pelvic Discontinuity ◽  
Proximal Migration ◽  
Radicular Symptoms ◽  
Acetabular Defects ◽  
Acetabular Components ◽  
Acetabular Loosening

Introduction Stemmed acetabular components are used in patients undergoing revision total hip arthroplasty in cases with major acetabular defects or pelvic discontinuity. Conflicting results relating to the survival of the component, and complication rates are reported in the literature. We present a case of L5 radiculopathy secondary to proximal migration of this device. Case description A 79-year-old man was admitted to our department in 2012 with increasing pain and paresthesias, initially diagnosed as left L5 radiculopathy. In 2002, he had undergone revision surgery due to aseptic loosening of the acetabular component with a stemmed acetabular cup. Radiological findings were severe osteolysis around the acetabular cup with proximal migration. MRI showed osteolysis involving the left L5/S1 facet joint and evidence of soft tissue in the left foramina encasing the L5 radicular nerve. Nerve conduction and electromyography studies revealed chronic L5 radiculopathy. Discussions This case report illustrates the importance of considering acetabular loosening in a patient presenting with radicular symptoms. If a stemmed acetabular cup is chosen for an acetabular reconstruction, careful surgical technique should be employed in order to achieve durable fixation. If the patient has pelvic discontinuity, other options of reconstruction have showed better outcomes in the literature.

High Proximal Migration in Cemented Acetabular Revisions Operated with Bone Impaction Grafting; 47 Revision Cups Followed with RSA for 17 Years

2016 ◽  
Vol 27 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Maziar Mohaddes ◽  
Peter Herberts ◽  
Henrik Malchau ◽  
Per-Erik Johanson ◽  
Johan Kärrholm
Keyword(s):  
Demographic Data ◽  
Base Line ◽  
Impaction Grafting ◽  
Bone Implant ◽  
Proximal Migration ◽  
Early Migration ◽  
Bone Impaction Grafting ◽  
Acetabular Components ◽  
Acetabular Loosening

Background Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup. Patients and Methods 43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up. Results here were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups. Discussion Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.

scholarly journals Multicup reconstruction technique for the management of severe protrusio acetabular defects

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Baochao Ji ◽  
Guoqing Li ◽  
Xiaogang Zhang ◽  
Yang Wang ◽  
Wenbo Mu ◽  
...  
Keyword(s):  
Survival Rate ◽  
Bone Ingrowth ◽  
Harris Hip Score ◽  
Reconstruction Technique ◽  
High Survival ◽  
Level Of Evidence ◽  
Therapeutic Study ◽  
Acetabular Defects ◽  
Acetabular Components ◽  
Acetabular Loosening

Abstract Background In revision hip arthroplasty, managing the large protrusio acetabular defects remains a challenge. The report described a novel technique which employs a trabecular metal revision shell as a super-augment to buttress the superior medial structure. Methods Between January 2015 and December 2018, the multicup reconstruction was performed in 21 patients with severe protrusio acetabular defects. The revision shell, plus two similar porous acetabular components was implanted into the initial shell to create a “multicup” construct. The functional outcomes were evaluated in terms of the Harris Hip Score. Acetabular loosening, restoration of hip center of rotation, and bone ingrowth etc., were radiographically assessed. The survival rate of the implants was also evaluated. Results A followup lasting a mean time of 31 months (range, 18–57 months) revealed that the average Harris Hip Score improved from preoperative 37.0 ± 7.1 to postoperative 76.4 ± 9.0. There were no revisions due to acetabular loosening. The horizontal offset increased by an average of 14 mm, and the vertical offset decreased by an average of 18 mm. Eighteen of the 21 patients (86 %) met at least 3 of 5 criteria associated with bone ingrowth. The survivorship free from re-revision for acetabular loosening after 2 years was 100 %. Conclusions The multicup reconstruction technique was a simplified re-revision procedure for managing the severe protrusio acetabular defects and could achieve a high survival rate. Level of evidence Therapeutic study, Level IVa.

scholarly journals Midterm Results Of Flanged Acetabular Cup Used In Severe Acetabular Defects

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0011
Author(s):  
Arun Kumar Pandey
Keyword(s):  
Hip Arthroplasty ◽  
Womac Score ◽  
Revision Hip Arthroplasty ◽  
Acetabular Cup ◽  
Biological Fixation ◽  
Pelvic Discontinuity ◽  
Require Time ◽  
Bone Allografts ◽  
Kaplan Meier ◽  
Acetabular Defects

Background: Revision hip arthroplasty complicated by massive acetabular defects and/or pelvic discontinuity has remained difficult to manage, with no definite option to produce predictable results. Acetabular cages and reinforcement rings have high failure rates because of lack of biological fixation. Custom triflange cups are economically demanding like cup-cage constructs, and require time to be fabricated. Cementless acetabular cup having an ischial hook and three iliac flanges is a technically simple but effective option to be used in such situations. Questions/purposes: We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on HSS and WOMACscores; (3) radiological outcomes based primarily on component migration; (5) mean operative time and (4) the complication rate for a series of 18 procedures. Methods: We conducted a retrospective review of all the revision hip arthroplasty procedures performed between January 2013 and May 2015 and identified 18 procedures in 18 patients where a cementless porous-coated hemispherical cup (Combicup-R, Link) was used. According to AAOS classification, 8 of the 18 (44%) acetabuli had Type 3 defect and 10 of 18 (56%) acetabuli had Type 4 defect. Structural bone allografts were used in 7 cases and all cases required morsellized allograft. The minimum followup was of 49 months and average was of 58 months (range, 49–67 months; SD, 34.3). Postoperative clinical evaluation was done at 6 weeks, 3, 6, and 12 months, and annually thereafter. HSS and WOMAC scores were recorded at follow up and radiographs were taken. Serial radiographs were compared with the 6-week postoperative radiographs to evaluate for component loosening/migration and structural graft resorption. Results: The 6-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1–97.4). HSS and WOMAC score improved significantly from a preoperative value of 54 and 43 respectively to 87 and 85 postoperatively (p < 0.001). One patient had resorption of structural allograft and subsequent cup migration, which needed re- revision surgery. Conclusions: Porous coated acetabular cup supplemented with flanges and hooks is a suitable option to treat severe acetabular defects and pelvic discontinuity in acetabular revision reconstructions, than cages which do not provide biological fixation. Compared to custom triflange cups, they are more economical, technically easier to implant and do not require any waiting period to be fabricated.

Assessment of an Orthopaedic Templating Software Package for Uncemented Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 155-157
Author(s):  
Michael Newman ◽  
David Hartwright
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Pelvic Radiograph ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Stems ◽  
Hip Arthroplasties ◽  
Acetabular Components ◽  
Insight Into

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

Retrieval and Radiographic Analysis of the Contour Antiprotrusio Cage

2017 ◽  
Vol 27 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Jonathan M. Vigdorchik ◽  
Richard S. Yoon ◽  
Susannah L. Gilbert ◽  
Joseph D. Lipman ◽  
Mathias P. Bostrom
Keyword(s):  
Average Length ◽  
Biomechanical Analysis ◽  
Acetabular Reconstruction ◽  
Pelvic Discontinuity ◽  
Intact Group ◽  
Future Design ◽  
Severe Bone Loss ◽  
Macroscopic Findings ◽  
Centre Of Rotation ◽  
Methods Of Treatment

Introduction Acetabular reconstruction in the setting of severe bone loss or pelvic discontinuity remains a challenging problem. Multiple methods of treatment have been described including antiprotrusio cages (APCs). The objective of this study is to combine biomechanical analysis of retrieved APCs with radiographic and clinical data to determine which factors influence or predict APC failure. Methods 41 APCs were identified. Sequential radiographs were examined for cage and polyethylene cup abduction angles, change in centre of rotation, screw placement, progression of cage failure, and failure mechanism. Cages were manually examined for gross macroscopic findings, breakage, and the location of breakage. High-resolution microscopy was used for further analysis. Results 24 cages were included in the analysis. Mean age of patients was 64.5 years (range 43-85 years); average length of implantation was 42.5 months (range 3-108 months). Average cage abduction angles were 56°; abduction for the cemented polyethylene cup was 44°. 14 of 24 cages were broken; 10 were intact. Of the broken cages, 10/14 broke through a screw hole in the ischial flange or just superior to the ischial flange. In the intact group, 6/10 failed due to pullout of the ischial screws. Discussion All cages had superior and lateralised centres of rotation. The majority of cages failed due to breakage or pullout at the ischial flange. Pelvic discontinuity was a large risk factor for a broken cage. Future design and technique modifications may result in superior outcomes in these complex acetabular reconstructions.

scholarly journals Erratum to: Management of pelvic discontinuity in revision hip arthroplasty using a cementless acetabular cup with an iliac stem in combination with a cranial strap

2019 ◽  
Vol 48 (4) ◽  
pp. 350-350
Author(s):  
Mohamed Ghanem ◽  
Dirk Zajonz ◽  
Rima Nuwayhid ◽  
Christoph Josten ◽  
Christoph Eckhard Heyde ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Acetabular Cup ◽  
Pelvic Discontinuity

Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up

2019 ◽  
Vol 101-B (3) ◽  
pp. 311-316 ◽  
Author(s):  
J. Löchel ◽  
V. Janz ◽  
C. Hipfl ◽  
C. Perka ◽  
G. I. Wassilew
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Screw Fixation ◽  
Acetabular Revision ◽  
Revision Total Hip Arthroplasty ◽  
Pelvic Discontinuity ◽  
Acetabular Defects

Aims The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique. Patients and Methods Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity. Results The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001). Conclusion The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316.

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