Acetabular Reconstruction in Paprosky Type Iii Defects

Cano, Jaime José Morales de; Guillamet, Llorenç; Pons, Arturo Perez

doi:10.1590/1413-785220192701187313

Cited by 5 publications

(3 citation statements)

References 37 publications

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“…But on many occasions it is difficult for the surgeon to change a component that is not loose due to the danger of associated bone fractures. In acetabular bone defects, the placement of jumbo-type acetabular components has been proposed, successfully reported in some studies, 19 the use of support rings associated with allograft placement, 20 , 21 the use of large diameter has helped a lot in revision surgery. 22 But we know that these heads increase torsional forces at the junction of the trunion and the heads and can cause adverse local alterations, in addition to being an important cause of postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

The Cemented Double Mobility Cup in Hip Revision: Different Possibilities of Use

Cano

Trias

2023

Acta ortop. bras.

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Introduction: The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods: The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results: The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion: The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series.

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Section: Discussionmentioning

confidence: 99%

The Cemented Double Mobility Cup in Hip Revision: Different Possibilities of Use

Cano

Trias

2023

Acta ortop. bras.

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“…Managing large acetabular defects remains a challenging task in revision total hip arthroplasty (THA) [ 1 – 4 ], usually correlated with mechanical deficiency [ 2 ]. Goals include reconstructing bone morphology and optimal positioning of the acetabular component to restore centre of rotation (COR) and leg lengths (LL) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

Laura

Henckel

Gal

et al. 2021

BMC Musculoskelet Disord

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Background 3D Surgical planning has become a key tool in complex hip revision surgery. The restoration of centre of rotation (CoR) of the hips and leg length (LL) are key factors in achieving good clinical outcome. Pelvic imaging is the gold standard for planning and assessment of LL. We aimed to better understand if 3D planning is effective at equalising LL when large acetabular defects are present. Materials and methods This was a prospective case study of 25 patients. We report the analysis of pre-operative LL status and planned LL restoration measured on CT, in relation to the achieved LL measured post-operatively in functional, weight bearing position. Our primary objective was the assessment of restoration of CoR as well as the anatomical and functional LL using biplanar full-length standing low-dose radiographs; our secondary objective was to evaluate the clinical outcome. Results Pre-operative intra-pelvic discrepancy between right and left leg was a mean of 28 mm (SD 17.99, min = 3, max = 60 mm). Post-operatively, the difference between right and left vertical femoral offset (VFO), or CoR discrepancy, was of 7.4 mm on average, significantly different from the functional LL discrepancy (median = 15 mm), p = 0.0024. Anatomical LLD was a median of 15 mm. In one case there was transient foot drop, one dislocation occurred 6 months post-operatively and was treated by closed reduction, none of the patients had had revision surgery at the time of writing. Mean oxford hip score at latest follow up was 32.1/48. Discussion This is the first study to investigate limb length discrepancy in functional position after reconstruction of large acetabular defects. We observed that VFO is not an optimal surrogate for LL when there is significant bone loss leading to length inequality, fixed flexion of the knee and abduction deformity. Conclusions Although challenging, LLD and gait abnormalities can be greatly improved with the aid of an accurate surgical planning. Surgeons and engineers should consider the integration of EOS imaging in surgical planning of reconstruction of large acetabular defects.

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“…Patients with failed acetabular cup revision surgery frequently have severe bone cavities and segmented defects resulting in pelvic deficiency, and present a difficult situation for revision arthroplasty [3]. Specifically, to restore the pelvic bone stock, the acetabular component should be placed in the correct anatomical position and the joint stability optimized [4]. The reconstruction should permit stable fixation of the new acetabular component and should lead to the restoration of the center of rotation [5,6].…”

Section: Introductionmentioning

confidence: 99%

Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study

Dammerer

Blum

Putzer

et al. 2020

Arch Orthop Trauma Surg

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Purpose Restoration cages and bone allografts have been proposed to manage severe acetabular bone defects. We aimed to investigate the migration behaviour of a restoration cup and impacted allograft bone in severe acetabular defects with Einzel-Bild-Röntgen-Analyse (EBRA). Methods Applying a retrospective study design, 64 cases treated between 2009 and 2016 were reviewed. We determined the preoperative Charlson Comorbidity Index (CCI), pre- to postoperative WOMAC score, blood loss and functional outcome. From preoperative x rays, the acetabular deficiencies were classified according to Paprosky. Cup migration analyses were performed with EBRA. Results Mean age at surgery was 73 (range: 38–93) years. According to the classification by Paprosky et al., 50% (n = 32) of our patients showed a type III B and 28.1% (n = 18) a type III A defect. Radiological follow-up for migration analysis was 35 (range: 4–95) months. Migration analysis showed a mean cup migration of 0.7 mm (range: 5.7–9.6) medial and 1.8 mm (range: 1.7–12.6) cranial. Conclusion In conclusion, acetabular restoration cages in combination with bone impaction grafting showed a low revision rate at a mean follow-up of 35 months. Mean cup migration revealed low rates after 2 years and suggested a stable postoperative implant position.

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Acetabular Reconstruction in Paprosky Type Iii Defects

Cited by 5 publications

References 37 publications

The Cemented Double Mobility Cup in Hip Revision: Different Possibilities of Use

The Cemented Double Mobility Cup in Hip Revision: Different Possibilities of Use

Reconstruction of acetabular defects greater than Paprosky type 3B: the importance of functional imaging

Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study

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