A single centre study of 41 cases on the use of porous tantalum metal implants in acetabular revision surgery

Abstract

Background This study aims at investigating cup survival of porous tantalum revision cups and identifies risk factors for failure. Methods We retrospectively reviewed 41 patients treated between 2010 and 2012. Main indications were aseptic loosening in 83% and two-stage exchange after periprosthetic joint infection in 17% of cases. Mean follow-up period was 72 months. Femoral megaprostheses were used in 13% of cases. Most defects were classified as Paprosky 3b (29%). Function was assessed using the Harris Hip score. Results Aseptic cup survivorship was 80% at 104 months (95% Confidence Interval 67.4–92.4). Overall implant survival was 73%. Major bone loss defects (Paprosky types 2c to 3b) were associated with a significantly higher rate of failure than minor defects ( P = 0.002). There were eight cases of aseptic loosening (19.5%) and two of infection (4.9%). Previous surgeries, indication for acetabular revision, patient-related risk factors and use of megaprostheses did not significantly influence implant survival. The Harris Hip Score improved from a median of 40 (Interquartile range 31–45) to 82 (interquartile range 65–88) postoperative ( P < 0.0001). Conclusions In summary, the use of porous tantalum metal implants in acetabular revision surgery achieves good to excellent short- term and mid-term functional results and an acceptable complication rate relative to the extent of defect and previous surgery. However, one should be aware of potential limitations of the implants in addressing large defects and discontinuity.

Custom-made 3D-printed cup-cage implants for complex acetabular revisions: evaluation of pre-planned versus achieved positioning and 1-year migration data in 10 patients

“… 2018 , Theil et al. 2019 ). However, the difficulty in treating Paprosky type III acetabular defects lies in the presence of extensive bone loss, jeopardizing proper placement of acetabular components due to loss of normal bony landmarks, affecting both primary stable fixation and the restoration of the hip center.…”

“…Desirable prerequisites for successful and durable revision include viable host bone, adequate surgical technique, and a stable and durable implant. Reconstruction of large acetabular defects with trabecular augments or reconstruction cages can be done with wellknown methods (Lopez et al 2018, Theil et al 2019. However, the difficulty in treating Paprosky type III acetabular defects lies in the presence of extensive bone loss, jeopardizing proper placement of acetabular components due to loss of normal bony landmarks, affecting both primary stable fixation and the restoration of the hip center.…”

Acetabular “up-and-in” defect treated with in-situ femoral head autograft technique during total hip arthroplasty

“…Trabecular metal augmentation has also been described for acetabular defects, with 73%-92% survivorship reported at 8-10 years. However, evidence beyond that point is limited [24], [25].…”

Feasibility and preliminary efficacy of tantalum components in the management of acetabular reconstruction following periacetabular oncologic resection in primary malignancies

“…Acetabular defects after periacetabular oncologic resection can be comparable to a revision of total hip arthroplasty (THA), in which porous tantalum components have been successfully used in achieving a mechanically stable hip structure [ 8 ]. The porous tantalum components possess several advantages over conventional cementless cups: higher percent volume of porosity, freely communicating pores, a bony-similar flexibility, higher coefficient of friction and biocompatibility for osseointegration and bony ingrowth [ 9 ]. Excellent results have been achieved with modular porous tantalum shells in revision THAs, with or without the use of tantalum augments or buttresses in a mid-term to long-term follow-up period [ 10 , 11 ].…”