Mid-term Outcomes of Using Custom-Made Implants for Revision Hip Arthroplasty

Abstract

Introduction. The matter of the replacement of acetabular defects is becoming increasingly relevant today. In their clinic the authors used custom-made implants with trabecular coating for replacement of defects in the acetabulum where and when it was necessary to ensure extended fixation of the component. Purpose — to evaluate short-term clinical and functional outcomes, osteointegration of porous coated custom-made implants, the overall survival of structural components and to identify the causes of failures and complications. Materials and Methods. During the study the authors interviewed and evaluated radiographs of 48 patients operated from October 2015 to June 2018. The patients were interviewed before and after the surgery using the Oxford hip joint scale, quality of life EQ-5D and visual analogue pain scale. Radiographs were evaluated for a period of at least 12 months for the signs of osteointegration. Results. The average OHS scores increased from 14.9 (±7) to 37.6 (±7) (p<0.01). Quality of life according to the EQ-5D index increased from 0.2 (±0.2) to 0.7 (±0.2) (p<0.01). The average value by general health scales: before operations — 49 (±17) and 73 (±18) scores after surgeries (p<0.01). The average VAS pain score decreased from 73 (±10) to 19 (±19) points (p<0.01). Osteointegration was observed in 98 percent of cases. Migration of the implant with fracture of a flange was observed in one case. Conclusions. In the short-term follow up the use of custom-made implants significantly improves hip joint function and the patients’ life quality. Custom-made implants enable primary reliable fixation in case of complex acetabular defects. High rate of osteointegration is observed for custom-made implants with porous coating within at least 12 months. Longer follow-up is needed to evaluate long-term results.

Complex Revision Arthroplasty Planning with Telemedicine Expert Advice

“…Но, вследствие агрессивности продуктов износа и макронестабильности компонентов эндопротеза, иногда в течение длительного времени, возможно образование костных дефектов, компенсировать которые стандартными ревизионными системами невозможно. Единственным вариантом решения в данной ситуации является, пожалуй, использование индивидуальных конструкций [12,13].…”

“…Доля ревизий увеличилась с 4,84% в 2017 г. до 5,61% в 2019 г. При этом количество сложных ревизий, сопровождающихся большими костными дефектами, также растет. Компенсация дефектов кости и надежная фиксация компонентов эндопротеза -основные задачи ревизионного вмешательства [13]. Поэтому от тщательного планирования зависит успех каждой ревизионной операции.…”