Reliability and Intraoperative Validity of Preoperative Assessment of Standardized Plain Radiographs in Predicting Bone Loss at Revision Hip Surgery

Self Cite

121

Acetabular component revision in the context of large contained bone defects with less than 50% host bone contact traditionally have been treated with roof reinforcement or antiprotrusio cages. Trabecular Metal TM cups (Zimmer, Inc, Warsaw, IN) may offer a reasonable treatment alternative. We evaluated the clinical and radiographic outcome of this mode of treatment. We prospectively followed 53 hip revision acetabular arthroplasty procedures performed with Trabecular Metal TM cups for contained defects with 50% or less contact with native bone. All patients were clinically and radiographically evaluated for evidence of loosening or failure. Minimum followup was 24 months (average, 45 months; range, 24-71 months). Contact with host bone ranged from 0% to 50% (average, 19%). The mean postoperative Merle d'Aubigne-Postel score was 10.6 (range, 1-12), with a mean improvement of 5.2 (range, À4-10) compared to the preoperative score. Two failed cups (4%) were revised. Two additional cups (4%) had radiographic evidence of probable loosening. Complications included four dislocations and one sciatic nerve palsy. The data suggest treatment of cavitary defects with less than 50% host bone contact using Trabecular Metal TM cups, without structural support by augments or structural bone grafts, is a reasonable option.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Trabecular Metal™ Cups for Acetabular Defects With 50% or Less Host Bone Contact

Lakstein

Backstein

Safir

et al. 2009

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121

“…The acetabular bone loss was classified according to the Gross classification [26]. The revisions requiring a cup-cage were either Type IV, which is an uncontained (segmental) loss of bone stock involving [ 50% of the acetabulum and affecting both columns (26 hips [39%]), or Type V, defined as an acetabular defect in association with pelvic discontinuity (41 hips [61%]).…”

Section: Patient Inclusion and Data Collectionmentioning

confidence: 99%

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity

Amenábar

Rahman

Hetaimish

et al. 2016

Self Cite

Background Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cupcage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. Questions/purposes We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. Methods All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. Results The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93

“…Radiographs underestimate bone loss due to osteolysis, with sensitivity for lesion detection ranging from 15-72% depending on size and location [5]. They are also limited by poor interobserver reliability [14,44]. Although there have been advances in the radiographic analysis of wear rates [16,31], these methods still provide indirect evidence of biological reactions and intracapsular pathology.…”

Section: Introductionmentioning

confidence: 99%

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Cooper

Ranawat

Potter

et al. 2010

Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.