Minor Column Structural Acetabular Allografts in Revision Hip Arthroplasty

Woodgate, Ian; Saleh, Khaled J.; Jaroszyński, G; Agnidis, Zoe; Woodgate, M M; Gross, Allan E.

doi:10.1097/00003086-200002000-00009

Cited by 57 publications

(26 citation statements)

References 36 publications

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“…Structural acetabular allografts are associated with higher complication rates where the allograft supports more than 50% of the implanted components [25]. The results of minor column defects (\ 50% of implanted component supported by graft) indicate that survivorship of 80% at a mean followup of 10 years with aseptic loosening as the endpoint may be achieved [42], falling to 55% at 20 years [22]. When a major column graft is used (typically when [ 50% of the implanted component is supported by graft), survivorship of 55% at a mean followup of 7 years has been shown [14].…”

Section: Discussionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

103

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Background Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments. Questions/purposes The purpose of this study was to assess the survivorship, clinical outcomes, restoration of center of rotation of the hip, and radiological signs of component fixation of trabecular metal augments in the context of reconstruction of acetabular defects. Methods Between 2002 and 2005, we performed 56 revision (n = 53) and primary (n = 3) THAs using trabecular metal augments in combination with a trabecular metal acetabular component. Of the 56 patients, 16 (29%) died during followup. Of the 40 surviving patients, 37 (93%) had complete radiological followup, 23 (58%) had complete outcome questionnaire followup, and 17 (42%) provided partial questionnaire responses in the clinic or over the telephone. Median followup was 110 months (range, 88-128 months). During that period, we used these implants when preoperative templating indicated that an augment would be required to achieve acetabular implant stability with restoration of the hip center of rotation. We also chose during surgery to use an augment when we could not achieve a stable acetabular trial component without one. The combination of trabecular metal augments and trabecular metal shells was used in 18% (53 of 292) of our acetabular revisions during that time. Survivorship, functional outcome (WOMAC and Oxford hip score), health status (SF-12), and osseointegration according to the criteria of Moore and presence of radiolucencies were determined.

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Section: Discussionmentioning

confidence: 99%

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

Whitehouse

Masri

Duncan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

103

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“…Despite reasonable function and survival from midterm reports [20,25], reports of long-term results are lacking. In this long-term study on minor column allograft, we have assessed and reported on the (1) rerevision rates for cup and graft with 15-and 20-year Kaplan-Meier survivorships for aseptic loosening and for all causes; (2) radiographic graft union rates, the presence/extent of graft resorption and the presence/extent of cup migration; (3) functional outcomes at 1 year and at last followup; and (4) other associated complications.…”

Section: Discussionmentioning

confidence: 99%

“…For Type 3 uncontained acetabular bone loss in which there is more than 30% but less than 50% acetabular bone loss, options for acetabular reconstruction include the use of impaction bone grafting [1,23], acetabular reinforcement ring [6,18], oblong cup [8,10], uncemented cup with high hip center [13], structural allograft (minor column or shelf graft) [20,25], and trabecular metal cup with augment [11,19,21,24]. Concerns have been expressed over early component migration and failure with impaction bone grafting in uncontained segmental acetabular bone defects.…”

Section: Introductionmentioning

confidence: 99%

“…Studies reporting on the use of uncemented oblong cups were few with 90% midterm survivorships, but no long-term results [8,10]. Trabecular metal cups and augments has been associated with survivorships around 97% at 3 years [11,19,21,24] while minor column acetabular allografts around 80% survivorship at 10 years with cup revision for aseptic loosening as endpoint [7,20,25]. However, there remains a concern about further resorption, collapse, and failure.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously reported a cup survivorship of 80% (n = 51) and a graft survivorship of 94% for revision arthroplasty with type 3 acetabular defect [25]. The mean followup period was 9.9 years (5.7 to 16.3) with failure defined as rerevision for aseptic loosening.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty

Lee

Raz²,

Safir³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background While acetabular structural allografts provide an important alternative for reconstructions, concerns remain with long-term graft resorption, collapse, and failure. Midterm studies of minor column (shelf) allograft suggest reasonable survival but long-term survival is unknown. Questions/purposes We therefore assessed long-term graft/cup survivorship, functional scores, radiographic resorption, and complications associated with minor column allograft. Methods We retrospectively reviewed 74 patients (85 hips) with a mean age of 54 years (range, 28-83 years) undergoing acetabular cup revision using a minor column allograft. A minor column allograft was used in uncontained acetabular bone defects sized between 30% and 50% of the acetabulum. Graft failure was considered to occur when the graft required revision with another graft, metal augment, reconstruction cage, or excision arthroplasty. The minimum followup was 5 years (mean, 16 years; range, 5.3-25 years). Results Twenty-three patients (27 hips) had rerevision for all causes at a mean time to rerevision of 6.9 years (range, 0.1-23). Fifteen grafts failed at a mean time-to-rerevision of 6.1 years (range, 0.5-23.2). The 15-and 20-year Kaplan-Meier survivorships were 61% and 55% for cups and 78% for grafts with rerevision for all causes as end point. With rerevision for aseptic loosening as end point, survivorships were 67% and 61% for cups and 81% for grafts. The mean modified Harris hip scores were 41 (range, 20-60) preoperatively, 73 (range, 40-95) at 1 year postoperatively and 73 (range, 26-93) at last followup.

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