Acetabular Revision in THA Using Tantalum Augments Combined with Impaction Bone Grafting

Gehrke, Thorsten; Bangert, Yannic; Schwantes, B.; Gebauer, Matthias; Kendoff, Daniel

doi:10.5301/hipint.5000044

Cited by 34 publications

(24 citation statements)

References 28 publications

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“…Acetabular impaction grafting has shown promising results with 87% survivorship for aseptic loosening at 20 years and 75% for any cause of failure [30]; however, it is technically demanding, time-consuming, and may be associated with higher failure rates in massive bone loss [6]. Combining the technique with trabecular metal augments to support large areas of graft offers promising early results [15].…”

Section: Discussionmentioning

confidence: 99%

“…Gustke et al [19] and Patel et al [27] reported average Harris hip scores (HHSs) of 72 and 81, respectively, after reconstruction with jumbo cups. Schreurs et al [31] reported an average HHS of 79 after reconstruction with impaction grafting and Gehrke et al [15] an average HHS of 82 when combining impaction grafting with a trabecular metal augment. The use of the combination of trabecular metal augments and shells allowed us to restore the center of rotation and therefore biomechanics of the hips in the majority of the patients in our series.…”

Section: Discussionmentioning

confidence: 99%

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Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

103

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Background Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. Questions/purposes The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. Methods Between 2002 and 2005, we performed 56 revision (n = 53) and primary (n = 3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

103

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“…Metal augments try to create peripheral acetabular containment to facilitate graft impaction [16]. Different series have been recently published reporting good preliminary results [3,13,15,16].…”

Section: Discussionmentioning

confidence: 99%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular-revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

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“…Dowodem wytrzymałości i dużej stabilności implantów wykonanych z porowatego tytanu są bardzo dobre wyniki jego zastosowania u chorych rewidowanych z powodu obluzowania endoprotezy stawu biodrowego z przerwaniem ciągłości obręczy miednicy [27][28][29]. Chropowatość powierzchni porowatego tytanu zapewnia początkową stabilność osadzonych implantów [30][31][32]. Unikalną cechą porowatego tytanu jest też wykazywana w badaniach jego zwiększona osteointegracja [33,34].…”

Section: Discussionunclassified

“…The durability and high stability of implants manufactured from trabecular titanium is evidenced by excellent outcomes of their use in patients undergoing revision surgery due to loosening of hip im plants associated with pelvic discontinuity [27][28][29]. The rough texture of the trabecular titanium surface ensures initial implant stability [30][31][32]. A unique fe a ture of trabecular titanium is also its increased osteointegration, demonstrated in studies [33,34].…”

Section: Wnioskimentioning

confidence: 99%

Use of Trabecular Titanium Implants for Primary Hip Arthroplasty

Kaminski

Szmyd

Ambroży

et al. 2016

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp.Aloplastyka całkowita stawu biodrowego jest procedurą wykonywaną coraz częściej. W dużej liczbie przypadków nieuchronnie znajdują się pacjenci, u których mimo pierwotnego charakteru zabiegu niezbędne jest uzupełnienie ubytków kostnych panewki stawu biodrowego. Stosowane w tych przypadkach przeszczepy kostne auto-i alogenne oraz pierścienie oporowe wymagają długiego odciążania, aby umożliwić wgojenie przeszczepów. Częściowo wady tej pozbawione są wypełnienia wykonane z porowatego tytanu. Celem pracy jest przedstawienie naszych wyników zastosowania uzupełnień z porowatego tytanu w aloplastykach pierwotnych.Materiał i metody. Do badania włączono grupę 23 chorych (18 kobiet i 5 mężczyzn), którym w latach 2010-2015 w Krakowskim Centrum Rehabilitacji i Ortopedii w czasie pierwotnej aloplastyki stawu biodrowego wszczepiono implant z porowatego tytanu.Wyniki. W średnim okresie obserwacji zanotowano poprawę w zmodyfikowanej i tradycyjnej skali Harris'a oraz redukcję dolegliwości bólowych w skali VAS. Nie zanotowano obluzowania ani infekcji implantu. Zastosowanie porowatego tytanu pozwoliło zmniejszyć liczbę koniecznych do użycia przeszczepów kostnych.Wnioski. 1.Uzupełnienie ubytków panewki implantami z porowatego tytanu może być stosowane w aloplastykach pierwotnych stawu biodrowego z dobrym wynikiem klinicznym i radiologicznym. 2. Zastosowanie uzupełnień z porowatego tytanu pozwala zmniejszyć liczbę przeszczepów kostnych niezbędnych do uzupełnie-nia ubytków panewki i pozwala na natychmiastowe, częściowe obciążanie kończyny.Słowa kluczowe: porowaty tytan, całkowita aloplastyka stawu biodrowego, ubytek panewki SUMMARY Background. Total hip arthroplasty is an increasingly common procedure. The large number of cases inevitably includes patients who require filling of their acetabular defect even in their primary surgery. The use of a utogenous grafts and allografts as well as resistance rings requires patients to avoid loading the limb for a long time to enable implant integration. This disadvantage may be partially eliminated by using trabecular titanium implants. The aim of this paper is to present the outcomes of the use of trabecular titanium implants in primary hip arthroplasty.Material and methods. The study embraced 23 patients (18 women and 5 men) whose primary hip arthroplasty was performed in the Cracow Centre of Rehabilitation and Orthopaedics in the period 2010-2015 and involved placement of a trabecular titanium implant.Results. Medium-term follow-up revealed improvement according to the modified and traditional Harris Hip Score and reduction in pain according to VAS. Loosening of the implant or infection were not recorded. The use of trabecular titanium allowed for reducing the amount of bone grafts used.Conclusions. 1. Reconstruction of acetabular defects with trabecular titanium implants may be used in primary hip arthroplasty to produce good clinical and radiographic outcomes. 2. The use of trabecular titanium implants allows for reducing the amount of bone grafts necessary to fill the ace...

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Acetabular Revision in THA Using Tantalum Augments Combined with Impaction Bone Grafting

Abstract: The combination of tantalum-augmentation with impaction allografting is a promising technique to manage severe uncontained acetabular defects.

Cited by 34 publications

References 28 publications

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

Use of Trabecular Titanium Implants for Primary Hip Arthroplasty

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