Acetabular bone defects in THA revision: Reconstruction using morsellised virus-inactivated bone allograft and reinforcement ring. Seven-year outcomes in 95 patients

Villatte, Guillaume; Érivan, Roger; Salles, Gilles; Pereira, Bruno; Galvin, Myriam; Descamps, Stéphane; Boisgard, Stéphane

doi:10.1016/j.otsr.2017.03.008

Cited by 18 publications

(10 citation statements)

References 32 publications

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“…Implant migration of more than 5 mm was observed in all 32 analyzed cases in this study. This is in contrast to a recent study of Villatte et al, 2017, who assessed the 5.9-year radiological survival rate of acetabular revision treatments with bone allografts and reinforcement ring in 71 patients and found such high migration rates in only 9 patients [24]. A high correlation between implant migration in cranial direction and relative bone volume loss in Cranial (R = 0.74), as well as a moderate correlation between implant migration in posterior direction and relative bone volume loss in Posterior was found (R = 0.66).…”

Section: Discussioncontrasting

confidence: 63%

Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets

et al. 2019

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ObjectivesAcetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to analyze 50 bone defects and to present the results and correlations between the defined parameters.MethodsThe analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed.ResultsBone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and [25, 75]—percentile values of 72.8 [50.6, 95.0] %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 [1.1, 1.4] with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° [21.5°, 40.4°], which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 [14.8, 32.7] mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67).ConclusionWithin this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.

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Section: Discussioncontrasting

confidence: 63%

Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets

et al. 2019

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“…25,37 Graft incorporation varied from 60% to 100%. 8,9,38 Villatte et al 29 in a series of morsellised allografts and Müller rings found a satisfactory graft osteointegration with an Oswestry score ⩾2 in 95.8% of patients and an Oswestry score ⩾4 in 49.3% of patients.…”

Section: Discussionmentioning

confidence: 96%

“…10,[25][26][27][28] Studies employing the Müller ring reported an overall survival rate varying from 84.5% to 95% at mid-term mean follow-up (5.9-8 years). 29,30 On the other hand, studies using the Ganz ring reported a survival rate of 89 to 96% at a mean follow-up of 5-8 years. 7,30 The Ganz reinforcement ring has a high failure rate in pelvic discontinuity with an estimated Kaplan-Meier 5-year survival of 57% in type IV defects as reported by Hourscht et al 31 Although the mid-term survival rates of those cages and rings could be similar to that of the Trabecular Titanium devices, the lack of a porous coating for bone in-growth could affect the long-term fixation with an associated high risk of implant migration or hardware failure.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup

et al. 2018

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Introduction: This study evaluates mid-term results of acetabular revision using a hemispherical acetabular cup in Trabecular Titanium with a cage construct. Methods: We reviewed 36 acetabular revisions performed with the Delta Revision TT cup in 34 patients (mean age = 75, range: 45-92 years). Acetabular defect types (Paprosky classification) included (1) 2B (n = 5), (2) 2C (n = 7), (3) 3A (n = 15), and (4) 3B (n = 9). Morcellised bone allografts were used in 24 cases, and synthetic bone used in 11. Outcomes were evaluated using the Harris Hip Score (HHS), and the Verbal Rating Scale (VRS) for pain measurement. X-ray visualisation of cup position was used to discern signs of mobilisation and bone graft incorporation. Survivorship at post-revision follow-up (mean = 39.8; range 12-91.5 months) was calculated. Results: HHS increased from 40.5 to 87 (p < 0.01). 68% of cases were pain free; by comparison, 32% had an average VRS score of 1.9 (range 1-3). The average cup inclination angle was 40.8° (30-52°) postoperatively, compared with 41.2° (30-52°) at follow-up; there were no signs of loosening or mobilisation. Centre of rotation was fully restored in 21 (58.3%) hips. According to Gie classification; bone graft incorporation grades were (1) 3 (n = 21), (2) 2 (n = 12) and (3) 1 (n = 2). The survival rate was 100% for aseptic loosening and 91.7% for any cause of revision. Conclusions: The Delta Revision TT cup promises good clinical and radiographic results at short-to mid-term followup, with high rates of survival rate and bone integration.

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“…Bone defects are common in the clinic and are usually associated with diseases, such as infection, osteolysis, original implant loosening or tumor excision. Clinically, bone loss has been addressed with methods such as cement, autogenous bone grafts, and artificial implants [ 1 , 2 ]. However, autogenous bone grafts are painful and source-limited, and are accompanied with complications, such as donor site morbidity [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Design and analysis of three-dimensional printing of a porous titanium scaffold

Yang

Shi

et al. 2021

BMC Musculoskelet Disord

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Objective Mechanic strength, pore morphology and size are key factors for the three-dimensional (3D) printing of porous titanium scaffolds, therefore, developing optimal structure for the 3D printed titanium scaffold to fill bone defects in knee joints is instructive and important. Methods Structural models of titanium scaffolds with fifteen different pore unit were designed with 3D printing computer software; five different scaffold shapes were designed: imitation diamond-60°, imitation diamond-90°, imitation diamond-120°, regular tetrahedron and regular hexahedron. Each structural shape was evaluated with three pore sizes (400, 600 and 800 μm), and fifteen types of cylindrical models (size: 20 mm; height: 20 mm). Autodesk Inventor software was used to determine the strength and safety of the models by simulating simple strength acting on the knee joints. We analyzed the data and found suitable models for the design of 3D printing of porous titanium scaffolds. Results Fifteen different types of pore unit structural models were evaluated under positive pressure and lateral pressure; the compressive strength reduced when the pore size increased. Under torsional pressure, the strengths of the imitation diamond structure were similar when the pore size increased, and the strengths of the regular tetrahedron and regular hexahedron structures reduced when the pore size increased. In each case, the compressive strength of the regular hexahedron structure was highest, that of the regular tetrahedron was second highest, and that of the imitation diamond structure was relatively low. Fifteen types of cylindrical models under a set force were evaluated, and the sequence of comprehensive compressive strength, from strong to weak was: regular hexahedron > regular tetrahedron > imitation diamond-120° > imitation diamond-90° > imitation diamond-60°. The compressive strength of cylinder models was higher when the pore size was smaller. Conclusion The pore size and pore morphology were important factors influencing the compressive strength. The strength of each structure reduced when the pore size (400, 600 and 800 μm) increased. The models of regular hexahedron, regular tetrahedron and imitation diamond-120°appeared to meet the conditions of large pore sizes and high compressive strength.

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Acetabular bone defects in THA revision: Reconstruction using morsellised virus-inactivated bone allograft and reinforcement ring. Seven-year outcomes in 95 patients

Abstract: IV, retrospective case-series study.

Cited by 18 publications

References 32 publications

Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets

Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets

Clinical and radiological outcomes of acetabular revision with the Delta Revision TT cup

Design and analysis of three-dimensional printing of a porous titanium scaffold

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