Technical factors for success with metal ring acetabular reconstruction

Udomkiat, Pacharapol; Dorr, Lawrence D.; Won, Ye Yeon; Longjohn, Donald B.; Wan, Zhinian

doi:10.1054/arth.2001.27669

Cited by 84 publications

(65 citation statements)

References 21 publications

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“…Our functional outcome score at final followup as reflected in the HHS (mean, 44.2) is noticeably lower when compared with scores from previous studies that used the same measurement tool, with their scores ranging from 66 to 82.8 [27,35,37,41]. There may be two reasons for this.…”

Section: Discussioncontrasting

confidence: 70%

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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: Discussioncontrasting

confidence: 70%

“…However, in this study, the authors primarily reported the results of allograft bone for acetabular revision and thus included reconstructions with cage and noncage devices. Similar mixing of cage reconstruction with other methods occurred in other studies [4,13,35], thus precluding easy comparison of outcomes.…”

Section: Introductionmentioning

confidence: 95%

Acetabular Cage Survival and Analysis of Factors Related to Failure

Sembrano

Cheng

2008

Clinical Orthopaedics &Amp; Related Research

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“…Although the use of structural bone grafts that provide auxiliary support initially might achieve cage stability, subsequent bone resorption may cause loosening and displacement of the cage. Udomkiat et al [33] used metal rings to perform acetabular revision in 64 patients and conducted a 5-year followup study that showed patient susceptibility to implant loosening and displacement is increased substantially if more than 60% of the weightbearing area is filled with bone graft. Paprosky et al [22], studying a sample of 11 patients who underwent cage revision for complex bone defects, reported that all seven failures in their cohort were caused by ineffective bone support.…”

Section: Discussionmentioning

confidence: 99%

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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“…Zastosowanie przeszczepów alogennych ubitych (impaction grafting) lub strukturalnych często daje niezadowalające wy niki [4,5]. Problem nie zawsze rozwiązuje także stosowane w aloplastykach rewizyjnych połączenie przeszczepu kostnego z pierścieniem oporowym [6][7][8].…”

Section: Wstępunclassified

“…The use of compact allografts (impaction grafting) or structural grafts in many cases does not provide satisfactory outcomes [4,5]. Likewise, a combination of a bone graft and a resistance ring is also not always an adequate solution [6][7][8]. An additional drawback of all the above techniques is that the patient may not load the operated joint until the grafts have integrated with native bone, i.e.…”

Section: Introductionmentioning

confidence: 99%

Use of Trabecular Titanium Implants for Primary Hip Arthroplasty

Kaminski

Szmyd

Ambroży

et al. 2016

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp.Aloplastyka całkowita stawu biodrowego jest procedurą wykonywaną coraz częściej. W dużej liczbie przypadków nieuchronnie znajdują się pacjenci, u których mimo pierwotnego charakteru zabiegu niezbędne jest uzupełnienie ubytków kostnych panewki stawu biodrowego. Stosowane w tych przypadkach przeszczepy kostne auto-i alogenne oraz pierścienie oporowe wymagają długiego odciążania, aby umożliwić wgojenie przeszczepów. Częściowo wady tej pozbawione są wypełnienia wykonane z porowatego tytanu. Celem pracy jest przedstawienie naszych wyników zastosowania uzupełnień z porowatego tytanu w aloplastykach pierwotnych.Materiał i metody. Do badania włączono grupę 23 chorych (18 kobiet i 5 mężczyzn), którym w latach 2010-2015 w Krakowskim Centrum Rehabilitacji i Ortopedii w czasie pierwotnej aloplastyki stawu biodrowego wszczepiono implant z porowatego tytanu.Wyniki. W średnim okresie obserwacji zanotowano poprawę w zmodyfikowanej i tradycyjnej skali Harris'a oraz redukcję dolegliwości bólowych w skali VAS. Nie zanotowano obluzowania ani infekcji implantu. Zastosowanie porowatego tytanu pozwoliło zmniejszyć liczbę koniecznych do użycia przeszczepów kostnych.Wnioski. 1.Uzupełnienie ubytków panewki implantami z porowatego tytanu może być stosowane w aloplastykach pierwotnych stawu biodrowego z dobrym wynikiem klinicznym i radiologicznym. 2. Zastosowanie uzupełnień z porowatego tytanu pozwala zmniejszyć liczbę przeszczepów kostnych niezbędnych do uzupełnie-nia ubytków panewki i pozwala na natychmiastowe, częściowe obciążanie kończyny.Słowa kluczowe: porowaty tytan, całkowita aloplastyka stawu biodrowego, ubytek panewki SUMMARY Background. Total hip arthroplasty is an increasingly common procedure. The large number of cases inevitably includes patients who require filling of their acetabular defect even in their primary surgery. The use of a utogenous grafts and allografts as well as resistance rings requires patients to avoid loading the limb for a long time to enable implant integration. This disadvantage may be partially eliminated by using trabecular titanium implants. The aim of this paper is to present the outcomes of the use of trabecular titanium implants in primary hip arthroplasty.Material and methods. The study embraced 23 patients (18 women and 5 men) whose primary hip arthroplasty was performed in the Cracow Centre of Rehabilitation and Orthopaedics in the period 2010-2015 and involved placement of a trabecular titanium implant.Results. Medium-term follow-up revealed improvement according to the modified and traditional Harris Hip Score and reduction in pain according to VAS. Loosening of the implant or infection were not recorded. The use of trabecular titanium allowed for reducing the amount of bone grafts used.Conclusions. 1. Reconstruction of acetabular defects with trabecular titanium implants may be used in primary hip arthroplasty to produce good clinical and radiographic outcomes. 2. The use of trabecular titanium implants allows for reducing the amount of bone grafts necessary to fill the ace...

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Technical factors for success with metal ring acetabular reconstruction

Cited by 84 publications

References 21 publications

Acetabular Cage Survival and Analysis of Factors Related to Failure

Acetabular Cage Survival and Analysis of Factors Related to Failure

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

Use of Trabecular Titanium Implants for Primary Hip Arthroplasty

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