Bone Remodeling Around Porous Metal Cementless Acetabular Components

Background Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. Questions/purposes We evaluated the incidence of osteolytic lesions after THA using a monoblock porous tantalum acetabular component. Methods We retrospectively reviewed 51 patients who had a THA using a monoblock porous tantalum acetabular cup. At a minimum of 9.6 years postoperatively (average, 10.3 years; SD, 0.2 years; range, 9.6-10.8 years), a helical CT scan of the pelvis using a metal suppression protocol was obtained. This scan was evaluated for the presence of osteolysis.

Section: Discussionmentioning

confidence: 99%

A Monoblock Porous Tantalum Acetabular Cup Has No Osteolysis on CT at 10 Years

Moen

Ghate²,

Salaz

et al. 2011

“…The main goals of acetabular revision are to restore normal anatomy (ie, placing the acetabular component at the true hip center of rotation) and to achieve stable fixation of the acetabular component. Achieving these goals is challenging when the surgeon must deal with large acetabular defects and/or pelvic discontinuity [13,21].…”

Section: Introductionmentioning

confidence: 99%

“…Implants in these optimal revision settings have shown excellent long-term survivorship ranging from 95% to 98% at 10 years [8,9,32]. Highly porous metal implants such as Trabecular Metal TM (TM) (Zimmer Inc, Warsaw, IN, USA) cups that offer improved bone ingrowth and biomechanical properties [3,5,14,21,33] have also shown encouraging results for acetabular revision [1,17,18,29]. However, it may be difficult or impossible to achieve stability, even with these highly porous metal implants, if the acetabular defect is large, bone quality is poor, there is limited host bone contact, or there is pelvic discontinuity.…”

Section: Introductionmentioning

confidence: 99%

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity

Amenábar

Rahman

Hetaimish

et al. 2016

101

Background Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cupcage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. Questions/purposes We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. Methods All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. Results The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93

“…In 2006, our group reported 100% survival in 12 THAs at 2 to 4 years followup with the use of porous tantalum acetabular implants following pelvic radiation therapy [20]. The high coefficient of friction and apparently high ingrowth rates in vivo associated with porous tantalum sockets have made it a potentially important implant material in irradiated bone [1,2,16,17] or complex revision situations [6,8,21]. However, if is unclear whether the high rate of survival initially reported would be maintained.…”

Section: Introductionmentioning

confidence: 99%

Tantalum Acetabular Cups Provide Secure Fixation in THA after Pelvic Irradiation at Minimum 5-year Followup

Joglekar

Rose

Lewallen

et al. 2012

Self Cite

Background Pelvic radiation has been commonly used to treat gastrointestinal, genitourinary, or hematopoietic malignancies. Conventional THA in these patients reportedly have high rates of fixation failure. Although secure short-term fixation reportedly occurs with trabecular metal implants following pelvic radiation, it is unclear whether the fixation is durable. Questions/purposes We determined the survival of trabecular metal acetabular components in patients having THA following pelvic radiation and assessed function and radiographic loosening. Methods We retrospectively reviewed 29 patients with prior pelvic radiation who had 34 arthroplasties using trabecular metal acetabular components from 1998 and 2005. The mean pelvic radiation dose was 6300 cGy. We collected the following data: patient demographics, surgery and implant information, clinical and radiographic followup, and tumor and radiotherapy related details. We obtained Harris hip scores (HHS) on all patients. Ten patients died of disease prior to 5 years and two patients were excluded, leaving 17 patients (22 hips) with a minimum of 5 years of clinical (mean, 78 months; median, 71; range, 57-116) and radiographic (mean, 73; median, 65; range, 51-116) followup.