Classification and Management of Acetabular Abnormalities in Total Hip Arthroplasty

DʼAntonio, James A.; Capello, William N.; Borden, Lester S.; Bargar, William L.; Bierbaum, Benjamin E.; Boettcher, William G.; Steinberg, Marvin E.; Stulberg, S. David; Wedge, John H.

doi:10.1097/00003086-198906000-00019

Cited by 449 publications

(303 citation statements)

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“…Sporer et al [31] reported a 37.5% failure rate after 2 to 8 years of followup for patients with massive acetabular defects treated with reconstruction cages. Loss of effective host bone contact and support for the cage is the leading cause of mechanical failure [3,5,6,15,26,31]. Although the use of structural bone grafts that provide auxiliary support initially might achieve cage stability, subsequent bone resorption may cause loosening and displacement of the cage.…”

Section: Discussionmentioning

confidence: 99%

“…A pelvic discontinuity was identified in four patients. We also classified the defect using the American Academy of Orthopaedic Surgeons (AAOS) classification as reported by D'Antonio et al [6]. Of the 26 patients treated with a custom cage, 22 had AAOS type III defects and four had AAOS type IV defects.…”

Section: Patientsmentioning

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%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…Cavitary bone defects are the most commonly encountered major bone deficits [3,10]. These defects represent a volumetric loss in bony substance of the acetabular cavity (including the medial wall), but the acetabular rim remains intact [4].…”

Section: Introductionmentioning

confidence: 99%

Trabecular Metal™ Cups for Acetabular Defects With 50% or Less Host Bone Contact

Lakstein

Backstein

Safir

et al. 2009

Clinical Orthopaedics &Amp; Related Research

122

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Acetabular component revision in the context of large contained bone defects with less than 50% host bone contact traditionally have been treated with roof reinforcement or antiprotrusio cages. Trabecular Metal TM cups (Zimmer, Inc, Warsaw, IN) may offer a reasonable treatment alternative. We evaluated the clinical and radiographic outcome of this mode of treatment. We prospectively followed 53 hip revision acetabular arthroplasty procedures performed with Trabecular Metal TM cups for contained defects with 50% or less contact with native bone. All patients were clinically and radiographically evaluated for evidence of loosening or failure. Minimum followup was 24 months (average, 45 months; range, 24-71 months). Contact with host bone ranged from 0% to 50% (average, 19%). The mean postoperative Merle d'Aubigne-Postel score was 10.6 (range, 1-12), with a mean improvement of 5.2 (range, À4-10) compared to the preoperative score. Two failed cups (4%) were revised. Two additional cups (4%) had radiographic evidence of probable loosening. Complications included four dislocations and one sciatic nerve palsy. The data suggest treatment of cavitary defects with less than 50% host bone contact using Trabecular Metal TM cups, without structural support by augments or structural bone grafts, is a reasonable option.

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“…Components that had tilted more than 5°or had migrated 2 mm or more or had a continuous radiolucent line greater than 2 mm in width were considered unstable. Acetabular and femoral defects were classified according to the grading system of the American Academy of Orthopaedic Surgeons [6,16]. The radiographic classification of each case was performed by an orthopaedic surgeon not involved in the cases, and the classification was confirmed with the surgeon postoperatively after review of the surgical details, the medical record, and the radiographs.…”

Section: Analysis Of Radiographsmentioning

confidence: 99%

High Complication Rate in Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis

Goodman¹,

Hwang²,

Imrie³

2013

Clin Orthop Relat Res

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Background Revision total hip arthroplasty (THA) in patients with juvenile idiopathic arthritis (JIA) is challenging as a result of the patient's young age, systemic disease, multiple affected joints, small proportions, and bone loss. The intermediate-to long-term results of these surgeries remain unknown. Questions/purposes The purpose of this study is to determine the (1) functional outcomes; (2) surgical complications; and (3) frequency of reoperation or revision after revision THA for JIA. Methods We reviewed the records of all patients from one center who underwent revision THA for JIA who had a minimum of 5 years of followup (mean, 9 years; range, 5-19 years). This resulted in a series of 24 revision THAs in 15 patients. All patients were Charnley Class C. Age at revision averaged 35 years (range, 21-53 years). The 20 acetabular and 12 femoral revision components included 15 cementless cups, five reconstruction/roof rings with a cemented cup, and four cemented and eight cementless femoral stems. Results The Harris hip scores improved from 54 (range, 34-85) to 77 (range, 37-100) (p \ 0.001). Complications included two proximal femoral fractures associated with severe osteolysis and one sciatic nerve palsy in a patient with severe acetabular deficiency. A total of seven hips (29%) required reoperation or revision surgery, including three for infection (one early and two late) and four for mechanical loosening. Conclusions Revision THA in JIA is very challenging owing to patients' small proportions and compromised bone stock. The intraoperative and early complication rates are relatively high. Prognosis for long-term survivorship is guarded; limiting factors include periprosthetic osteolysis associated with older implants that used conventional polyethylene and cemented stems.

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Classification and Management of Acetabular Abnormalities in Total Hip Arthroplasty

Cited by 449 publications

References 0 publications

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

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

Trabecular Metal™ Cups for Acetabular Defects With 50% or Less Host Bone Contact

High Complication Rate in Revision Total Hip Arthroplasty in Juvenile Idiopathic Arthritis

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