Bridging Massive Acetabular Defects With the Triflange Cup

Christie, Michael J.; Barrington, Steven A.; Brinson, Martha F.; Ruhling, Marc E.; DeBoer, David K.

doi:10.1097/00003086-200112000-00024

Cited by 140 publications

(122 citation statements)

References 19 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Similarly, Holt and Dennis [15], who used custom triflange cups, reported Harris hip scores that increased from 39 preoperatively to 78 at an average last followup 4.5 years later. Taunton et al [32] reported a Harris hip score of 75 at an average followup 5 years after surgery, and Wind et al [36] reported an increase from 38 preoperatively to 63 at an average followup 3 years after surgery (Table 2) [5,8,10,15,16,32,36]. Our approach using individualized custom cages in patients with significant acetabular defects showed equal or better hip scores than the aforementioned series, for patients with comparable (or worse) defects and with longer followup.…”

Section: Discussionmentioning

confidence: 60%

“…Such a study would likely require a multiinstitutional approach. Previous studies have shown the primary disadvantages of custom cages to be their high cost in time and money [5,10]. Although this approach was relatively economic at our center (CT scanning and model creation cost approximately USD 500, and the cost of custom cage manufacture, including the cup, screws, and polyethylene liner, was approximately USD 5000), this can vary widely from center to center, and our study was not a cost analysis.…”

Section: Discussionmentioning

confidence: 95%

“…Once the appropriate position of the cage has been determined, our rapid-prototyping models indicate if the superior acetabulum provides sufficient contact and support for the cage; if not, a modified crest or 3-D printed augment can be added to the superior surface of the cage. Dislocation is a frequent problem with triflange cups, occurring in 16% to 26% of hips [5,9,32,36]. Dislocations are more common after difficult revision procedures like these because of component malposition, an absent or damaged abductor mechanism, or inadequate soft tissue tension [5,15,25].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the variability in the shape of the pelvis and in the size and shape of acetabular defects often results in a relatively poor fit of the off-the-shelf cage to host bone; this is important, because achieving cage stability on host bone is the main challenge in using acetabular reconstruction cages. Revision methods that result in good initial stability on host bone achieve good long-term results, whereas methods that rely on bone graft or compromised host bone for stability have dramatically increased rates of failure [3,5,6,22,26]. Cup-cage constructs with a porous metal acetabular component covered by a cage fixed proximally and distally have shown good short and mid-term results, but longerterm followup is necessary [1,2].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Mao

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes morestraightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach. Questions/purposes For patients with severe (Paprosky IIIB) defects, we asked: do individualized custom cages result in (1) improved Harris hip scores; (2) restoration of hip center; and (3) a low incidence of surgical complications? Methods Twenty-six patients (26 hips) with a massive acetabular defect were involved in this study from 2003 to 2013. During this period, one patient was lost to followup and one died, leaving 24 patients (eight males, 16 females) in this retrospective analysis. The customized cages were individualized to each patient's bone defect based on rapidprototype three-dimensional printed models. Mean followup was 67 months (range, 24-120 months). Harris hip scores were assessed before surgery and at each followup. Postoperative radiographs were evaluated for cage position, migration, and graft incorporation. Complications and reoperations were assessed by chart review. Results The mean Harris hip score improved from 36 (SD,8; range, to 82 (SD, 18; range, 60-96) (p \ 0.001). Individualized custom cages resulted in generally reliable restoration of the hip center. No rerevisions have been performed. None of the cups showed radiographic migration, but one cage was believed to be loose, based on a circumferential 2-mm radiolucent line. Cancellous allografts appeared to be incorporated in 23 of 24 patients. One deep infection and one superficial infection were observed and treated with irrigation, débridement, and vacuumsealing drainage. One dislocation and one suspected injury of the superior gluteal nerve also were observed and treated conservatively. Conclusions Individualized custom cages using rapid prototyping and three-dimensional printing appeared to provide stable fixation and improved hip scores at shortterm followup in this small, single-center series. As further improvements in the design and manufacturing process are made, future studies should evaluate larger patient groups for longer times, and, ideally, compare this approach with alternatives for these complex bone defects.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Mao

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Material issues and fixation can be addressed by the use of a custom triflange. Christie et al [3] reported on 78 acetabular reconstructions performed with a custom triflange component of which 32 involved an AAOS Type IV defect. At mid-term followup 94% (30/32) of the reconstructions showed healing of the pelvic discontinuity.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%