Cementless acetabular revision: past, present, and future

Pulido, Luis; Rachala, Sridhar R.; Cabanela, Miguel E.

doi:10.1007/s00264-010-1198-y

Cited by 115 publications

(51 citation statements)

References 43 publications

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“…Different techniques have been suggested in cup revision surgery [32] and the revision surgeon must be familiar with several approaches to cover all types of patients and bone defects. In the absence of comparative studies, observational studies might be able to act as guidance to the orthopaedic surgeons in decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…According to Kurtz et al [21], revision hip arthroplasties are projected to increase twofold by 2030. Cemented fixation when revising the cup and the stem was common until the mid-1980s [32]. A high rate of failure for this technique (16%-48% at 4.5-11.9 years) [19,20,31] and a belief that the cement itself had a destructive effect on the bone tissue [7] encouraged the use of uncemented fixation in hip revision surgery [8,12,22].…”

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confidence: 99%

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Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Mohaddes

Garellick

Kärrholm

2013

Clinical Orthopaedics &Amp; Related Research

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Background During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups. Question/purposes We determined (1) the risk of rerevision after cemented and uncemented fixation; (2) the influence of concomitant stem revision on the risk of rerevision of the cup; (3) the difference in risk of rerevision of an uncemented cup revision compared with liner revision only; and (4) whether the surgical incision influenced the risk of rerevision. Methods Between 1979 and 2010, 19,342 first-time cup revisions were reported to the Swedish Hip Arthroplasty Register. From these, 749 were excluded (hip resurfacing, cases with tumor diagnoses, and missing data) leaving 18,593 (73% cemented) for further analysis. We used a Cox regression model adjusted for age, sex, primary diagnosis, method of fixation, concomitant stem revision, and cemented/uncemented fixation to assess risk of rerevision. Results The relative risk for rerevision for any reason did not differ between cemented and uncemented fixation (relative risk [RR], 0.94). If the stem was not revised at index revision, the risk of further cup revision increased twofold (RR, 1.91). Liner revisions were associated with a 70%

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Mohaddes

Garellick

Kärrholm

2013

Clinical Orthopaedics &Amp; Related Research

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“…Small contained defects can usually be treated with porous hemispherical cups with supplemental bone grafting [6]. However, large uncontained lesions often require extralarge hemispherical cups, impaction grafting, structural allografts, bilobed oblong cups or anti-protrusio rings and reconstruction cages [7][8][9][10][11][12][13][14][15][16]. Although the results of cementless fixation appears to be satisfactory in many revision scenarios, less satisfactory outcomes have been reported in some studies when less than 50 % of the weight bearing host bone is available for fixation, which may lead to failure of biological ingrowth [17].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, suboptimal outcomes have been reported with reconstruction cages in patients with Paprosky 3A and 3B acetabular defects [18,19]. These challenges have led to new approaches to manage acetabular defects with highlyporous metals during revision arthroplasty [16].…”

Section: Introductionmentioning

confidence: 99%

Systematic review on outcomes of acetabular revisions with highly-porous metals

Banerjee

Issa

Kapadia

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. Method A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. Results The mean aseptic survivorship was 97.2 % (range, 80-100 %). The Harris hip scores improved from a mean preoperative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of periacetabular radiolucencies was 2.4 % (range, 0-8.8 %) and 4.6 % (range, 0-19 %), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. Conclusion The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.

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“…Periprosthetic osteolysis related to cellular reactions to wear debris currently represents the weak link of very long-term implant survival, but a biological solution might be available in the future [11]. These complications may require revision surgery that should be addressed with a global strategy that aims at partial or total component revision [16], and the placement of cemented [7] or cementless [13] implants, often accompanied by the necessity to restore bone stock [5,18].…”

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confidence: 99%

Total Hip Arthroplasty, state of the art for the 21st century

Courpied

Caton²

2011

International Orthopaedics (SICOT)

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The main surgical procedure in orthopaedics at the turn of two centuries is without any doubt total hip arthroplasty. For this reason, the Editorial Board has asked us to moderate this special issue, now an annual feature in our Journal.After several trials during the first half of the 20th century, the first joint replacements in clinical practice were femoral head prostheses, including the one developed by Jean and Robert Judet in 1948 in France.In total hip arthroplasty, a major advance was made in 1962 by Sir John Charnley in the United Kingdom who introduced metal-on-plastic bearings including the low friction torque arthroplasty (LFA) combining a 22.2-mm head and a full polyethylene socket, both components being fixed to bone by methacrylate cement. The major advantage of LFA was the hard on soft friction couple, which is highly resistant to wear and breakage.Indeed, despite wear, a number of the all-polyethylene sockets after more than 20 years in vivo still provide a satisfactory clinical outcome, sometimes with no radiographic osteolysis. The usual wear rate of LFA using original, high density polyethylene sterilised with ethylene oxide was 0.1 mm/year, but the wear rate became greater when ethylene oxide was replaced by gamma irradiation in oxygen. The current standard using conventional polyethylene sterilised in an inert atmosphere has returned the wear rate to 0.1 mm/year. Impingement is a common phenomenon associated with total hip replacement. In the case of a hard-on-soft friction couple, as in Charnley-type LFA, this phenomenon has no catastrophic consequences in contrast to hard-onhard bearings (metal and ceramic), causing chipping for ceramic-on-ceramic or metal ions release and metallosis for metal-on-metal.Several papers have reported satisfactory outcomes for Charnley-type total hip arthroplasty. The Mayo clinic series published in 2002 [1] reported a survival rate free of revision for aseptic loosening at 25 years of 86.5% (68.7% in patients less than 40 years of age and 100% for patients older than 80 years). Wroblewski et al. [24] demonstrated a survival of 72.5% and 53.7% for the femoral and acetabular components, respectively, at 38-year follow-up using loosening as the endpoint. The results from Cochin Hospital (Paris, France) in patients less than 50 years old [8] indicated a survival of 96% at ten years and 89.5% at 20 years. The latest paper, published by Callaghan et al. on a series of patients operated by CR Jonhston in Iowa City [3], reported a survival of 78%±8% at 35 years.The goal of this special issue which includes 20 papers was to update the current state of the art in THA.THA is a widely performed procedure in the vast majority of countries. It could be stated that Charnley-type THA is the gold standard in view of the long-term results [17]. Collection and appreciation of the long-term results can be difficult [2], although registers are commonly used [10].Patient information and education cannot be ignored and has become part of function improvement. Surgical approaches...

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Cementless acetabular revision: past, present, and future

Abstract: This review focuses on the use of cementless implants for acetabular revision. The use of trabecular metal cups, augments, jumbo cups, oblong cups, cages, and structural grafting are also discussed.

Cited by 115 publications

References 43 publications

Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Systematic review on outcomes of acetabular revisions with highly-porous metals

Total Hip Arthroplasty, state of the art for the 21st century

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