Systematic review on outcomes of acetabular revisions with highly-porous metals

Abstract

Purpose The purpose of this study was to systematically review the literature and report the clinical and radiographic outcomes of highly-porous acetabular cups in revision settings. Method A literature search of four electronic databases of EMBASE, CINAHL-plus, PubMed, and SCOPUS yielded 25 studies reporting the outcomes of 2,083 revision procedures with highly-porous acetabular components. There was lack of high quality evidence (level I and level II studies) and only two studies with level III evidence, while the remainder were all level IV studies. In addition, a majority of the studies had small sample sizes and had short to mid-term follow-up. The mean age of the patients was 65 years (range, 58-72 years) and the mean follow-up was 3.6 years (range, two to six years). Outcomes evaluated were aseptic survivorship, Harris hip scores, migration rates, incidence of peri-acetabular radiolucencies and radiographic restoration of the hip centre. Results The mean aseptic survivorship was 97.2 % (range, 80-100 %). The Harris hip scores improved from a mean preoperative score of 42 points, (range, 29-75 points), to a mean postoperative score of 79 points (range, 69-94 points). The mean incidence of cup migration and prevalence of periacetabular radiolucencies was 2.4 % (range, 0-8.8 %) and 4.6 % (range, 0-19 %), respectively, at final follow-up. The vertical hip centre-of-rotation was restored significantly from a mean of 39.2 mm (range, 27.6-50 mm) pre-operatively, to a mean of 24.1 mm (range, 7.4-47 mm), postoperatively. Conclusion The short-term clinical and radiographic results of highly-porous metals in revision hip arthroplasty are excellent with a low rate of loosening in the presence of both major and minor bone loss.

Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years

“…The use of the combination of trabecular metal augments and shells allowed us to restore the center of rotation and therefore biomechanics of the hips in the majority of the patients in our series. A high center of rotation of the hip is defined as more than 35 mm above the interteardrop line [2,28] with a systematic review of the use of highly porous metals in acetabular revisions demonstrating correction from a mean of 39 mm to 24 mm [3]. Successful restoration of the hip center was achieved in all but five of the patients in the series.…”

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial

“…However, revision THA is considered a significantly more complex procedure than routine primary THA for several reasons: (1) extensive surgical approaches are commonly needed for exposure and implant or cement removal [11]; (2) bone defects encountered need to be addresses either with bone grafts or metal augments [12]; (3) modular revision implants are needed to obtain reliable implant fixation [13]. Therefore, revision THA often requires prolonged surgical time with rather large blood loss.…”

Comparison of the Primary Stability of Porous Tantalum and Titanium Acetabular Revision Constructs

“…Currently tantalum and titanium are the most frequently used metals in uncemented porous components due to their biologically inert nature and their physical properties that are close to those of cancellous bone [24][25][26][27]. In addition, a recent study by Brüggemann et al has shown little systemic response to tantalum implants, underscoring their safety in joint replacement procedures [28].…”