Long-term results of isolated acetabular revisions with reinforcement rings: a 10- to 15-year follow-up

Abstract

The management of severe acetabular bone deficiency and a stable femoral stem can be a challenging problem in revision hip surgery. Replacement of both the acetabular and femoral component in elderly patients can increase perioperative risks without the certainty of a better functional outcome. We report the long-term outcome of reinforcement rings in isolated acetabular revision to determine whether this procedure allows hip function restoration and implant longevity. Methods: A retrospective study was conducted to evaluate the long-term results of isolated acetabular revision in thirty patients with a mean age of 70.6 years. 16 patients (16 hips) received an acetabular reinforcement ring, and 14 patients received a reconstruction cage. Acetabular defects were classified as Paprosky Type II in 16 cases and Type III in 14 cases. The mean follow-up was 11.3 years (range 10-15 years). Results: Radiographic signs of loosening were found in 9 cases (30%). 4 cases (13.3%) with severe osteolysis and implant migration underwent further revision surgery. All 30 unrevised femoral stems were considered stable. 1 (3%) early dislocation, was conservatively treated. Clinical assessment showed a significantly improved mean Harris Hip Score from 45.1 points preoperatively to 85.4 at the latest follow-up (p < 0.05). The 15-year survival rate was 86.7%. Conclusions: Our long-term results showed that in selected patients, isolated acetabular revision with rings or antiprotrusio cages represents a reasonable surgical technique for the management of severe acetabular bone loss. However, concerns about the high radiographic loosening rates are possibly related to low bone ingrowth compared to new porous implants.

Vertebral Body Osteolysis 6 Years After Cervical Disk Arthroplasty

“…10 Periprosthetic osteolysis, which leads to loosening of the prosthesis, was described after total knee and hip arthroplasty. 4,5 Specific to the cervical spine, two reports described a cervical body osteolysis after implant of a metal-on-metal or metal-on-polymer (ball-and-socket) type of prosthesis. 11,12 A variety of factors have been proposed to explain the pathologic mechanism.…”

“…If fusion fails to occur, mechanisms for late prosthetic failure are osteolysis of adjacent bone structures. 4,5 In this case report, we present a rare case of vertebral body osteolysis in the presence of scar tissue, metallic and textile foreign bodies, and giant cell reaction that occurred several years after the implantation of two M6-C artificial cervical disks.…”

Use of 3D modelling and 3D printing for the diagnostic process, decision making and preoperative planning of periprosthetic acetabular fractures

“…According to bone quality and cup stability, the different possible solutions are reduction and fixation of the fracture, revision arthroplasty or the combination of the two techniques 15. Moreover, it is mandatory to state the fixation of the femoral stem and to opt in favour of a total revision or an isolated acetabular revision 17 18. Accurate preoperative planning is essential for choosing the most suitable surgical strategy.…”

Conservative treatment of early-onset tubercular periprosthetic joint infection following total knee arthroplasty

“…Periprosthetic joint infections represent one of the most common complication following joint arthroplasty, both after primary or revision surgery [18][19][20][21]. However tubercular PJI is a rare clinical condition in developed countries.…”