Acetabular Defects of Hip Tuberculosis: Recommended Classification and Reconstruction in Hip Arthroplasty

Abstract

Background: This study aimed to propose a classification of acetabular defects in advanced-stage hip tuberculosis based on preoperative radiographs and intraoperative evaluation, thereby providing options for reconstructing each type of defect in hip arthroplasty. Materials and Methods: We conducted a prospective study with 45 patients with active hip tuberculosis at stage IV who were treated with a total hip replacement strategy. We collected the patients' acetabular defect data from preoperative radiographs and intraoperative observations. The defects were classified into types based on defect severity and reconstructive complexity. The hip replacement outcomes were evaluated at least 12 months after the operation. Results: The classification system includes three types: type I: localized or extensive defects inside the acetabulum, not affecting the acetabular rim, medial wall, or columns. Type II: extensive defects inside the acetabulum, affecting the acetabular rim or (and) medial wall. Type III: extensive defects inside the acetabulum, causing the medial wall and the acetabular column to lose function. Each type has a corresponding reconstruction. The outcome includes that 41/45 patients had excellent results; 3/45 patients had good results. The patients had good results due to nerve and muscle damage caused by tuberculosis not related to the acetabular defects. Conclusion: This is a simple, practical classification system of acetabular defects in hip tuberculosis. The outcome of hip reconstruction using this classification was excellent without any cases of dislocation or protrusion.

3D‐printed Personalized Porous Acetabular Component to Reconstruct Extensive Acetabular Bone Defects in Primary Hip Arthroplasty

“…Reinforcement rings are commonly utilized in revision THA to address this issue 21 . Similarly, reinforcement rings (cup‐cage system) have been found to improve stability in primary THA for patients with hip tuberculosis and extensive acetabular defects 11 . In our study, flanged components were utilized in five out of seven patients to achieve a mechanically stable hip structure.…”

“… 21 Similarly, reinforcement rings (cup‐cage system) have been found to improve stability in primary THA for patients with hip tuberculosis and extensive acetabular defects. 11 In our study, flanged components were utilized in five out of seven patients to achieve a mechanically stable hip structure. During the follow up, no aseptic loosening or component protrusion was observed on the radiographs.…”

“…6,10 For these patients, THA is necessitated to restore the hip joint function. 11 However, acetabular bone defects pose significant challenges in the following hip arthroplasty. 12 Until now, management of extensive acetabular bone defects still requires high surgical techniques.…”

“…Especially, developmental dysplasia of the hip and posttraumatic osteoarthritis are also commonly accompanied by acetabular bone defects 6,10 . For these patients, THA is necessitated to restore the hip joint function 11 . However, acetabular bone defects pose significant challenges in the following hip arthroplasty 12 …”

“… 6 , 10 For these patients, THA is necessitated to restore the hip joint function. 11 However, acetabular bone defects pose significant challenges in the following hip arthroplasty. 12 …”