Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects

Abstract

Background Revision surgery for complex acetabular defects is still technically challenging. In this study, we discussed and compared the clinical and radiological outcomes of revision surgery between two methods using double-trabecular metal (TM) cups alone or combined with impacting bone grafting (IBG). Methods The records of 18 patients (18 hips) who underwent revision surgery using double-trabecular metal (double-TM) cups between 2008 and 2016 were retrospectively reviewed. All the patients were diagnosed with Paprosky III acetabular defects. The acetabular defects were reconstructed by double-TM cups alone or in combination with IBG. We used the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA), and Short Form 36 (SF-36) to evaluate the clinical outcomes. Pelvis plain X-ray was used to assess hip center of rotation (COR), abduction angle and anteversion angle of acetabular cup, and incorporation of the bone graft to host bone. Results The median follow-up time was 61.0 (IQR 56.0 to 65.8) months. No patients underwent re-revision for loosening or any other reasons. Complications included 3 patients (16.7%) with early dislocation and 3 patients (16.7%) with delayed wound healing. The average mHHS and UCLA preoperatively were 44.1 ± 4.0 (range 35 to 50) and 2.6 ± 0.7 (range 2 to 4), respectively and at the last follow-up were 73.7 ± 4.2 (range 68 to 85) and 7.3 ± 0.5 (range 7 to 8), respectively. The mean SF-36 scores at the last follow-up were improved significantly than preoperative scores, especially in bodily pain category ( P < 0.05). The average limb-length discrepancy (LLD) decreased significantly from 24.2 ± 2.6 (range 20 to 32) mm preoperatively to 5.8 ± 1.8 (range 3 to 9) mm at the last follow-up, respectively. However, there was no significant difference between two methods at the last follow-up in terms of mHHS, UCLA, SF-36, LLD, and hip COR ( P > 0.05). Radiographic evaluation demonstrated bone graft incorporation in all hips in the follow-up. Conclusions Defect reconstruction using double-TM cups alone or combined with IBG are practical and reliable treatment options for Paprosky III acetabular defects without pelvic discontinuity. Nevertheless, high postoperative complication rate, especially in terms of dislocation, remains a challenge.

Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

“…Our results are in line with recent papers reporting results with the use of trabecular metal (TM)-coated acetabular components that showed low risk of both aseptic and septic rerevision in cup revision surgery. These results are, in any case, comparable with those of non-TM components [ 4 , 5 , 17 ]. The main difference between trabecular titanium components and tantalum cups is the manufacturing system as they are produced with a 3D-printing technology known as electron beam melting (EBM), a high-energy focused beam used to locally melt metallic powders, layer upon layer, in a one-step manufacturing process.…”

“…Different kinds of coating or 3D structures are used to improve capability of a primary fixation and secondary osteointegration. Trabecular Metal ™ derived from Tantalum was the first porous material extensively used in hip (and knee) revision surgery with promising results [3][4][5]. Subsequently, different manufacturers developed different porous materials or coatings with different technologies [6].…”

Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group

“…However, the usually quoted percentage of minimum 50% contact between the cup and host bone was related to bulk grafts that have a different mode of incorporation and substitution from the fresh frozen chips impacted in 58% of Coptos TH cup cases and revealed full incorporation in 94% of the hips within 24 months. The value of the bone graft was to aid in cup stability, a carrier for the antibiotics, and restore bone stock in case future revision become necessary [23][24][25][26].…”

Clinical and radiological outcomes of combined modular prothesis and cortical strut for revision proximal femur in giant cell tumor of bone patients

“…We began to reconstruct when obtaining negative results of the microscopy and the rapid frozen pathological diagnosis during surgery. After obtaining the desired stable position, 16 we implanted the suitable acetabular cup. Based on the instability of the femoral stem, cortical strut allograft was used to reconstruct the bone volume and repair the intra-operative fracture.…”

“…The acetabular cup abduction angle and anteversion angle were measured or calculated on radiographs. 16 Instability of the femoral stem was defined as subsidence of greater than 5 mm. 9 We evaluated the incorporation of the cortical strut allograft to the host bone and graded the resorption of the allograft according to the technique of Kim et al 9 The criteria of osseointegration were applied to evaluate the ingrowth of the distal stems, and postoperative complications of loosening, subsidence, heterotopic ossifications, and stress shielding were reviewed and assessed.…”