Mueller reinforcement rings in acetabular revision Outcome in 164 hips followed for 2–17 years

Abstract

We found that mid- to long-term survival of the ARR is acceptable. However, failure of the implant due to allograft collapse/resorption or deep infection, and also poor clinical outcome, remain major concerns in acetabular revision arthroplasty. This should be recognized when advising patients.

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

“…There were six cup rerevisions and one graft failure in patients with mild resorption at a minimum followup of 4.4 years (mean, 16.2 years; range, 4.4-24.8 years) (one case was included with less than 5 years followup because of cup and graft failure). None of the three patients with moderate graft resorption had rerevision at a minimum followup of 11 years (mean, 14.7 years; range, [11][12][13][14][15][16][17][18][19][20][21][22]. The two patients with severe resorption had graft failure and rerevision at 4 and 23 years after the index surgery.…”

“…Concerns over migration and early failure remain with the use of impaction morselized allograft for uncontained acetabular segmental defects [1,23]. The survivorships associated with the use of Impacting bone grafting reinforcement ring were between 80 and 90% but with only 6 years mean followup duration [6,18]. The use of high hip center arthroplasty has been associated with inferior results to arthroplasty with normal hip centers [13].…”

“…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.…”

“…Van Haaren et al [23] reported a 72% survivorship at a mean followup of 7 years (1.6-10) with revision for aseptic loosening as endpoint and Buttaro et al [1] reported a 91% survivorship (n = 23) at a mean followup of 3 years (2-5) with 2 mm or more migration seen in all cups (median 3 mm, range, 2-25 mm). Acetabular reinforcement rings reportedly have more than 80% cup survivorships at 10 years [6,18]. The use of high hip center arthroplasty has not been widespread and has been associated with leg shortening, impinging instability, lower functional scores and survivorship.…”

“…The use of high hip center arthroplasty has not been widespread and has been associated with leg shortening, impinging instability, lower functional scores and survivorship. Morag et al [13] reported poorer survivorship (82% versus 94%), mean WOMAC scores (62 versus 70) and mean Harris Hip scores (70 versus 83) in patients with high hip centers ([ 35 mm above radiological teardrop, n = 31) compared to patients without high hip centers (n = 32) after revision at a mean followup of 10 years (range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Studies reporting on the use of uncemented oblong cups were few with 90% midterm survivorships, but no long-term results [8,10].…”