Revision Total Hip Arthroplasty for Pelvic Discontinuity

DeBoer, David K.; Christie, Michael J.; Brinson, Martha F.; Morrison, Joan

doi:10.2106/jbjs.f.00313

Cited by 98 publications

(95 citation statements)

References 9 publications

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“…Dislocations are more common after difficult revision procedures like these because of component malposition, an absent or damaged abductor mechanism, or inadequate soft tissue tension [5,15,25]. In our study, only one of 24 patients experienced dislocation, which appears to be less than reported with other techniques [5,9,15,32,36]. We believe that our method's reasonably accurate restoration of the hip center and its control of the inclination and anteversion of the cage contributed to restoring the tension of the soft tissue and reducing impingement between the cage and femoral neck.…”

Section: Discussionmentioning

confidence: 43%

“…Once the appropriate position of the cage has been determined, our rapid-prototyping models indicate if the superior acetabulum provides sufficient contact and support for the cage; if not, a modified crest or 3-D printed augment can be added to the superior surface of the cage. Dislocation is a frequent problem with triflange cups, occurring in 16% to 26% of hips [5,9,32,36]. Dislocations are more common after difficult revision procedures like these because of component malposition, an absent or damaged abductor mechanism, or inadequate soft tissue tension [5,15,25].…”

Section: Discussionmentioning

confidence: 99%

“…However, none of those options has been shown to predictably yield favorable results in the setting of massive periacetabular bone loss. Oversized hemispheric cups have shown good results [9]; however, the extent or geometry of the acetabular bone loss may preclude this option in the presence of more-severe bone defects [12]. Impaction grafting techniques may be inadequate for stabilizing pelvic discontinuity and do not typically provide adequate acetabular component stability in cases in which major portions of the anterior and posterior columns are absent [30,34,35].…”

Section: Introductionmentioning

confidence: 99%

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Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Mao

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Revision THA is particularly challenging in hips with severe acetabular bone loss. When the extent or geometry of the acetabular bone loss precludes morestraightforward techniques such as jumbo hemispheric cementless shells, reconstruction with morselized allograft protected by a custom cage may offer an alternative, but, to our knowledge, few series have reported on results with this approach. Questions/purposes For patients with severe (Paprosky IIIB) defects, we asked: do individualized custom cages result in (1) improved Harris hip scores; (2) restoration of hip center; and (3) a low incidence of surgical complications? Methods Twenty-six patients (26 hips) with a massive acetabular defect were involved in this study from 2003 to 2013. During this period, one patient was lost to followup and one died, leaving 24 patients (eight males, 16 females) in this retrospective analysis. The customized cages were individualized to each patient's bone defect based on rapidprototype three-dimensional printed models. Mean followup was 67 months (range, 24-120 months). Harris hip scores were assessed before surgery and at each followup. Postoperative radiographs were evaluated for cage position, migration, and graft incorporation. Complications and reoperations were assessed by chart review. Results The mean Harris hip score improved from 36 (SD,8; range, to 82 (SD, 18; range, 60-96) (p \ 0.001). Individualized custom cages resulted in generally reliable restoration of the hip center. No rerevisions have been performed. None of the cups showed radiographic migration, but one cage was believed to be loose, based on a circumferential 2-mm radiolucent line. Cancellous allografts appeared to be incorporated in 23 of 24 patients. One deep infection and one superficial infection were observed and treated with irrigation, débridement, and vacuumsealing drainage. One dislocation and one suspected injury of the superior gluteal nerve also were observed and treated conservatively. Conclusions Individualized custom cages using rapid prototyping and three-dimensional printing appeared to provide stable fixation and improved hip scores at shortterm followup in this small, single-center series. As further improvements in the design and manufacturing process are made, future studies should evaluate larger patient groups for longer times, and, ideally, compare this approach with alternatives for these complex bone defects.

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Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Mao

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…DeBoer et al [5] previously reported 20 hips with pelvic discontinuity treated with a triflange component at a mean of 10 years and found bridging callous in 18 of 20 hips.…”

Section: Introductionmentioning

confidence: 98%

Pelvic Discontinuity Treated With Custom Triflange Component: A Reliable Option

Taunton

Fehring

Edwards

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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188

136

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Background Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages. Questions/purposes We therefore determined (1) revision and overall survival rates, (2) discontinuity healing rate, and (3) Harris hip score (HHS) after treatment of pelvic discontinuity with a custom triflange acetabular component and (4) the cost of this reconstructive operation compared to other constructs. Methods We retrospectively reviewed 57 patients with pelvic discontinuity treated with revision THA using a custom triflange acetabular component. We reviewed operative reports, radiographs, and clinical data for clinical and radiographic results. We also performed a cost comparison with utilization of other techniques. Minimum followup was 24 months (average, 65 months; range, 24-215 months). Results Fifty-six of 57 (98%) were free of revision for aseptic loosening at latest followup. Fifty-four (95%) were free of revision of the triflange component for any reason. Thirty-seven (65%) were free of revision for any reason. Twenty-eight (49%) were free of revision for any reason and free of any component migration and had a healed discontinuity. Forty-six (81%) had a stable triflange component with a healed pelvic discontinuity. Average HHS was 74.8. The costs of the custom triflange implants and a Trabecular Metal 1 cup-cage construct were equivalent: $12,500 and $11,250, respectively.

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“…The implant manufacture generates individualized implants from the respective imaging (Fig. 4) 38 Taunton et al reported a revision rate of 30% (20/57) at 5.4 years and 21% dislocation rate most likely attributable to instability generated from pre-operative trochanteric escape performed in 51% of patients and possible traction injury to the superior gluteal nerve during exposure. 31 When comparing manufacture costs, triflange components are priced similar to other constructs used to treat pelvic discontinuity, including the ''cup-cage'' construct, a trabecular metal cup with an antiprotrusio cage (Zimmer, Inc, Warsaw, IN, USA).…”

Section: Custom Triflange Implantsmentioning

confidence: 99%

Clinical evaluation and surgical options in acetabular reconstruction: A literature review

Ahmad

Schwarzkopf

2015

Journal of Orthopaedics

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Revision Total Hip Arthroplasty for Pelvic Discontinuity

Abstract: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Cited by 98 publications

References 9 publications

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects

Pelvic Discontinuity Treated With Custom Triflange Component: A Reliable Option

Clinical evaluation and surgical options in acetabular reconstruction: A literature review

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