A cemented acetabular component with a reinforcement cross provides excellent medium-term fixation in total hip arthroplasty after pelvic irradiation

Abstract

Conventional cemented acetabular components are reported to have a high rate of failure when implanted into previously irradiated bone. We recommend the use of a cemented reconstruction with the addition of an acetabular reinforcement cross to improve fixation. We reviewed a cohort of 45 patients (49 hips) who had undergone irradiation of the pelvis and a cemented total hip arthroplasty (THA) with an acetabular reinforcement cross. All hips had received a minimum dose of 30 Gray (Gy) to treat a primary nearby tumour or metastasis. The median dose of radiation was 50 Gy (Q1 to Q3: 45 to 60; mean: 49.57, 32 to 72). The mean follow-up after THA was 51 months (17 to 137). The cumulative probability of revision of the acetabular component for a mechanical reason was 0% (0 to 0%) at 24 months, 2.9% (0.2 to 13.3%) at 60 months and 2.9% (0.2% to 13.3%) at 120 months, respectively. One hip was revised for mechanical failure and three for infection. Cemented acetabular components with a reinforcement cross provide good medium-term fixation after pelvic irradiation. These patients are at a higher risk of developing infection of their THA.

Letter to the Editor on “A Meta-Analysis of Outcomes in Total Hip Arthroplasty Recipients Following Pelvic Irradiation”

“…Plasma-sprayed implants had similar results in 1 study [8], and standard cementless implants failed almost half the time in 2 other series [9,10]. Cemented cage-like constructs appeared to be durable as well [11], highlighting the advantage of additional screw fixation. Interestingly, both cemented and cementless femoral fixation appeared to be successful and durable.…”

A rare presentation of haematuria: hip prosthesis in the bladder

“…Felden et al followed up 45 patients who had previous pelvic radiotherapy with a mean duration of 51 months following their hip surgeries 8. Using their novel technique of using a cemented acetabular component with a reinforcement cross, they concluded that the technique was excellent and provided a satisfactory outcome.…”

Uncemented Arthroplasty After Hip Metastatic Disease and Multiple Myeloma

“…To date, cemented components are the traditional surgical technique when a hip arthroplasty is indicated for pain or fracture after metastatic disease or multiple myeloma in the hip area. 3 , 11 - 13 Previous studies have described the use of composite allograft with uncemented arthroplasty in the treatment of primary bone tumors, 14 arguing that the cardiovascular risks associated with the use of cement could be avoided. This is also a strong argument in relation to patients with metastatic disease and multiple myeloma, as their overall health status is frequently compromised.…”