Acetabular defect classification and management

Ghanem, Mohamed; Zajonz, Dirk; Heyde, Christoph-Eckhard; Röth, Andreas

doi:10.1007/s00132-020-03895-8

Cited by 16 publications

(18 citation statements)

References 20 publications

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“…Although similarities exist between the different classification systems, each one has a unique grading scale ranging from mild to severe defects [ 42 ]. Therefore, bone structure must be analyzed and classified based on bone loss by a combination of preoperative AP overview, additional information about the anterior and posterior acetabular columns, computer tomographic imaging, and ultimately intraoperative findings of the bony configuration of the acetabulum [ 43 ]. The AAOS classification system has gained wide acceptance and is able to distinguish between segmental and cavitary defects, allowing for the practical, simplified assessment of bone defects and preoperative evaluation of acetabular defects, in turn enabling the proper preparation of surgical approach and determination of the necessary implants [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Acetabular Wall Weakening in Total Hip Arthroplasty: A Pilot Study

et al. 2023

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Total hip arthroplasty is a widely performed operation allowing disabled patients to improve their quality of life to a degree greater than any other elective procedure. Planning for a THA requires adequate patient assessment and preoperative characterizations of acetabular bone loss via radiographs and specific classification schemes. Some surgeons may be inclined to ream at a larger diameter thinking it would lead to a more stable press-fit, but this could be detrimental to the acetabular wall, leading to intraoperative fracture. In the attempt to reduce the incidence of intraoperative fractures, the current study aims to identify how increased reaming diameter degrades and weakens the acetabular rim strength. We hypothesized that there is proportionality between the reaming diameter and the reduction in acetabular strength. To test this hypothesis, this study used bone surrogates, templated from CT scans, and reamed at different diameters. The obtained bone surrogate models were then tested using an Intron 8874 mechanical testing machine (Instron, Norwood, MA) equipped with a custom-made fixture. Analysis of variance (ANOVA) was used to identify differences among reamed diameters while linear regression was used to identify the relationship between reamed diameters and acetabular strength. We found a moderate correlation between increasing reaming diameter that induced thinning of the acetabular wall and radial load damage. For the simplified acetabular model used in this study, it supported our hypothesis and is a promising first attempt in providing quantitative data for acetabular weakening induced by reaming.

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Section: Discussionmentioning

confidence: 99%

Acetabular Wall Weakening in Total Hip Arthroplasty: A Pilot Study

et al. 2023

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“…The rationale was that only three-point clamping beyond the hemisphere could provide sufficient rotational stability. Ghanem et al [ 13 ] also pointed out the importance of three-point fixation when faced with bone defects in revision arthroplasty in their study. However, the study did not specify the detailed requirements of the three-point distribution.…”

Section: Discussionmentioning

confidence: 99%

“…In RTHA, deciding whether using a cup alone can provide primary stability is critical in preoperative planning [ 13 , 20 , 21 ]. For surgeons, this may affect the surgical preparation and judgment of the difficulty of the surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Our previous study and clinical experience showed that the primary stability of the cup was achieved when the three-point support was distributed over the semicircle around the acetabulum. Mohamed et al [ 13 ] introduced a new classification system for acetabular bone defects based on the three-point fixation theory. However, the precise locations of these three points are not illustrated in detail [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Mohamed et al [ 13 ] introduced a new classification system for acetabular bone defects based on the three-point fixation theory. However, the precise locations of these three points are not illustrated in detail [ 13 ]. The rami ischii, rami ossis pubis, and the anterosuperior part of the acetabulum are anatomical structures that have the most bone stock and are most likely to have residual host bone left when bone defects occur around the acetabulum.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the feasibility of acetabular cup pre-determination in revision total hip arthroplasty via X-ray of the bone stock of the anterosuperior acetabulum

et al. 2021

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Purpose This study was aimed to explore (1) location on AP pelvic X-ray that displayed bone stock in anterosuperior acetabulum; (2) whether X-ray could provide enough evidence to evaluate whether bone stock could provide support for acetabular cup; (3) criteria to determine whether anterosuperior bone stock could provide sufficient support for cup on X-ray. Methods Our study retrospectively collected 43 patients who underwent revision THA for cup loosening from 2014 to 2019. The position of anterosuperior acetabular bone stock was compared between X-ray and CT-based 3-D reconstruction. Seventy-millimeter acetabular cup was implanted simulatively to obtain the contact line between acetabular cup and superolateral remaining bone stock. The contact line length and the angle were measured. Patients were divided into cup group and cage group, and ROC curves of both contact line length and angle were drawn. Results The superolateral part of acetabulum on X-ray could reflect the anterosuperior host bone stock of acetabulum according to the comparison of anteroposterior pelvic X-ray and 3-D reconstruction. Critical point was chosen when we got the highest sensitivity with a 100% specificity in ROC curves. The critical values of contact length and angle were 15.58 mm and 25.5°. Conclusions Surgeons could assess the anterosuperior bone stock of acetabulum by AP pelvic X-ray to decide whether revision could be done merely using cup or need customized cage. Clinically, when contact line length was larger than 16 mm or contact angle was larger than 25.5°, adoption of cup could obtain primary stability in the revision surgery in most cases.

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