Principles of Bone Grafting in Revision Total Hip Arthroplasty

Paprosky, Wayne G.; Magnus, Robert E.

doi:10.1097/00003086-199401000-00020

Cited by 150 publications

(68 citation statements)

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“…Using the D'Antonio/AAOS system [10], there were seven segmental or noncontained defects, 12 cavitary or contained, 29 combined, and 19 pelvic discontinuities. In the Paprosky system [22], there were 16 Type II defects (five IIA, eight IIB, and three IIC) and 51 Type III (28 IIIA and 23 IIIB) defects. In the Toronto system [29], there were six Type II, 26 Type III, 16 Type IV, and 19 Type V defects.…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, the goals of restoring or preserving pelvic bone stock, placing the acetabular component in the correct anatomic position, optimizing joint stability, equalizing leg lengths, and achieving stable fixation are not as readily achieved in such a situation [16]. Different ways of treating this problem have been proposed, including acceptance of a high hip center [28,30], cementing a cup onto structural bone graft [22], or using a bilobed cup [8], a custom triflanged cup [9,19], a jumbo cup [11,40], a trabecular metal cup with augments [20], or a reconstructive cage [5,24]. Despite the number of proposed solutions, none appear clearly superior over others, and pelvic deficiencies continue to be a perplexing problem.…”

Section: Introductionmentioning

confidence: 99%

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Acetabular Cage Survival and Analysis of Factors Related to Failure

Sembrano

Cheng

2008

Clinical Orthopaedics &Amp; Related Research

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The reported results of acetabular cage reconstruction for pelvic deficiency are widely variable. Our primary question was: what is the survivorship of cage reconstruction with a primary end point of cage revision and secondary end points of radiographic loosening and any reoperation? Secondary questions were: which factors predict cage failure, and what is the functional outcome (SF-36, WOMAC, Harris hip score) of this reconstructive method? We reviewed 72 cage reconstructions in 68 patients. Minimum followup was 1.2 years (mean, 5.1 years; range, 1.2-10.7 years). Five-year cage revisionfree survivorship was 87.8%. Five-year loosening-free and acetabular reoperation-free survivorships were 80.7% and 81.3%, respectively. No single preoperative factor (age, gender, severity of pelvic defect, degree of heterotopic ossification, difference in limb lengths and centers of rotation) or intraoperative factor (type of bone graft, type of cage, changes in limb length and center of rotation) predicted cage failure. Functional outcomes were 28.9 (SF-36 Physical Component), 52.4 (SF-36 Mental Component), 33.7 (WOMAC), and 44.2 (Harris). We judged these outcomes acceptable for this sometimes challenging problem.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acetabular Cage Survival and Analysis of Factors Related to Failure

Sembrano

Cheng

2008

Clinical Orthopaedics &Amp; Related Research

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“…The creation of a stable acetabular construct and the restoration of lost bone stock remain a significant challenge during revision hip arthroplasty [24]. Smaller bony defects can be addressed with porous-coated components [37].…”

Section: Introductionmentioning

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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“…The importance of returning the hip center to as near an anatomic position as possible has been reported in clinical studies [18,23,29]. Restoration of the hip center potentially will improve leg length differences, decrease limp, and help reestablish and maintain hip stability, mechanics, and range of motion [2,27].…”

Section: Discussionmentioning

confidence: 98%

“…Long-term results of Type III acetabular deficiencies with structural bone grafts and cementless or cemented components have not been as good as the results for Types I and II deficiencies [2,5,12,15,16,23]. Reported revision rates range from 20% to 30% with overall failure rates as much as 50% when Type III deficiencies are revised with a structural bone graft and cementless cups [15,24].…”

Section: Discussionmentioning

confidence: 99%