Safe Zone for Transacetabular Screw Fixation in Prosthetic Acetabular Reconstruction of High Developmental Dysplasia of the Hip

Liu, Q; Zhou, Yixin; Xu, Haijun; Tang, Jing; Guo, Shengjie; Tang, Qiheng

doi:10.2106/jbjs.h.01752

Cited by 20 publications

(19 citation statements)

References 12 publications

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“…The causes for cup failure were aseptic loosening or osteolysis (22), infection (two), dislocation (one), graft nonunion (one), and acetabular component fracture (one). The treatment for cup failure included cup-only exchange (12), cup rerevision with structural allograft, cage or metal augment (12), excision arthroplasty (two) and two-stage revision arthroplasty (one). Fifteen patients had graft failures at a mean time to rerevision of 6.1 years (range, 0.5-23).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…There was one intraoperative death from vascular complications despite pelvic angiography and iliac vessel embolization. This was due to screw placement outside the 'safe zone' [12].…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 53 patients (64 hips) had a mean age of 54 years (range, 28-83) at the time of surgery and a mean followup duration of 16 years (range, . Among the 53 patients, five patients died after a mean followup of 12 years (range, 7-15) and 10 were lost to followup after a mean followup of 12 years (range, [5][6][7][8][9][10][11][12][13][14][15][16][17]. There were 36 patients with more than 15 years followup and 16 patients with more than 20 years followup.…”

Section: Methodsmentioning

confidence: 99%

“…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].…”

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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…There was one intraoperative death from vascular complications despite pelvic angiography and iliac vessel embolization. This was due to screw placement outside the 'safe zone' [12].…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Hüftgelenkendoprothetik bei kongenitaler Dysplasie

et al. 2011

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Total hip arthroplasty is the procedure of choice for most patients with advanced, symptomatic osteoarthritis due to congenital dysplasia of the hip. However, the complexity of arthroplasty is significantly increased because of anatomic abnormalities associated with dysplasia of the hip. In addition the relatively young age of patients may affect survival of the implant. From a biomechanical standpoint the primary surgical objective is reconstruction of the anatomical center of rotation. Independent of the pelvic bone stock the socket should be located as near as possible to the anatomical acetabular location. There are various operative strategies to ascertain sufficient stability of the socket. The anterolateral deficiency of the acetabulum can be reconstructed by bulk femoral autografting or bone impaction grafting. Furthermore controlled perforation of the medial wall or implantation of reinforcement rings and oval sockets have been described. Cementless, biological socket fixation shows superior long-term results compared to cemented cups, especially in these young patients. The location of the reconstructed acetabulum and the desired leg length influence the type of femoral reconstruction and in some cases femoral shortening is required. In this article endoprosthetic reconstructive options for developmental dysplasia of the hip are discussed depending on the femoral and acetabular deformity.

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