The Burch-Schneider antiprotrusio cage: medium follow-up results

Abstract

With the development of hip prosthesis, younger patients may need more than one revision surgery, with less bone stock available in each subsequent surgery. We retrospectively reviewed the hip revision surgeries in which a Burch-Schneider device has been used. Patients were classified according to the Paprosky score. Functional and clinical evaluation was assessed by the Merlé-Daubigné score. Radiolucencies were assessed by Gill's criteria. Sixteen patients with a mean age of 66.1 years were reviewed at a mean follow-up of 60.7 months. According to Paprosky classification, 18.7% were grade IIb, 56.3% grade IIIa and 25% grade IIIb. The mean Merlé-Daubigné score improved from 10 to 15 points. Radiologically, 12 patients had no radiolucencies, two had grade I radiolucencies and two had grade III radiolucencies. In greater than 50% of acetabular defects, the Burch-Schneider seems to be useful providing clinical and functional improvement. Immediately, non-progressive radiolucencies are not associated with implant loosening at the end of follow-up. The ischial flap should be inserted inside the ischial portion of the acetabulum.

Analysis of the Results of Use of Bone Graft and Reconstruction Cages in a Group of Patients with Severe Acetabular Bone Defects

“…The reported rates of revision ranged from 0 to 16% [8,[17][18][19][20][21][22][23][24][25]. The incidence of failure or radiographic loosening in our study was 16% at an average of 5.4 years postoperatively, with the need for revision for this cause being 8.1% (2.7% without infection).…”

“…This could be explained by the following: the acetabular component to be removed often is associated with marked protrusio, fractured and migrated internal fixation, and cement and fibrous adhesions after the previous surgeries can be found. These factors often demand extensive exposure and retraction, which can be associated with stretching of the branches of the sciatic nerve [4,8,25]. Fixing the flange to the lateral surface of the ischium with screws, as we did, demands more exposure and retraction near the sciatic nerve; furthermore, the flange could act as an irritant, subsequently leading to sciatica [8].…”

“…Reconstruction with an antiprotrusio cage has a reported failure rate including radiographic loosening that ranges between 0 and 24% [17][18][19][20][21][22][23][24][25]. The reported rates of revision ranged from 0 to 16% [8,[17][18][19][20][21][22][23][24][25].…”

“…Slotting the inferior flange into the ischium is a technically demanding procedure but provides several advantages: a more stable fixation of the cage can be obtained in a more horizontal position. Moreover, the risk of sciatic nerve injury can be significantly decreased [4,8,25], because the ischiatic flap is inserted inside the ischium.…”

“…Inserting the ischial flange into the ischium could be a possibility to decrease nerve palsy injury and to improve mechanical stability [25].…”