Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects

Abstract

BackgroundRevision total hip arthroplasty (THA) with large acetabular defect remains a challenge. Though trabecular metal (TM) cup and augments have been introduced in defect reconstruction with good result, the accurate positioning of implant is important to avoid complications. Therefore, we aimed to evaluate the usefulness of three-dimensional (3D) simulation and 3D model in assisting implant positioning during complex revision THA.MethodsSixteen patients (18 hips) who underwent revision THA with a Paprosky type III acetabular defect were analyzed retrospectively. Placement of acetabular cup and TM augments was simulated with 3D simulation software and 3D model preoperatively. Cup anteversion, abduction angle, and hip center were measured in each case preoperatively and postoperatively. Primary outcome was the percentage of outliers according to Lewinnek safe zone and Harris hip score (HHS). Secondary outcome was the correlation between the 3D planned and the postoperative value.ResultsThe percentage of outliers was significantly corrected from 77.78% (14/18) preoperatively to 38.88% (7/18) postoperatively (p = 0.04). There was a significant correlation between mean planned cup anteversion and postoperative value (13.39 vs 11.99, r = 0.894; p < 0.001). There was a significant correlation between mean planned abduction and postoperative value (42.67 vs 44.91, r = 0.921, p < 0.001). The number of planned and used augments was the same in all the cases. In 15 cases (83.33%), the size of planned and used TM augments was the same. The HHS was significantly improved at final follow-up (80.94 vs 27.50, p < 0.001). No cases presented dislocation or radiological signs of loosening.ConclusionPreoperative 3D simulation and model were considered the useful method to assist implant positioning in revision THA with complex acetabular defect, with moderate to high accuracy and satisfied clinical outcome.

Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects

“…To fill the bone defects adequately and maximize the contact with the host bone, custom-made implants are one option to address large bone defects in revision surgery [ 27 ]. TM components could provide strong initial stability and promote a deep bony ingrowth with the design of high porosity and low modulus of elasticity [ 26 ]. Currently, some studies have been carried out to evaluate the effects of a novel treatment strategy of double-cup technique applied to manage Paprosky III acetabular defects without pelvic discontinuity, and double-TM cups reconstruction was considered a credible way for acetabular revision according to their short-term results [ 7 , 12 ].…”

“…Similarly, the malposition of the acetabular cup and femoral head size are common surgical factors for dislocation in revision THA [ 32 ]. With the help of preoperative 3D simulation and model, complex revision THA could be managed with moderate to high accuracy and satisfied clinical outcomes [ 26 ]. Larger femoral heads could reduce the rate of dislocation, so all patients in our study were applied with 32-mm heads.…”

“…Two independent authors retrospectively reviewed and evaluated radiological outcomes blindly to minimize bias and the inconsistent evaluation was resolved through discussion and consensus with additional two senior surgeons. The vertical and horizontal position of COR were defined as the distance from the COR to the inter-teardrop line and the distance from the COR to the floor of the acetabular teardrop, respectively [ 26 ]. We measured and calculated the acetabular cup abduction angle and anteversion angle on pelvic plain radiographs according to Lewinnek et al [ 20 ].…”

A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options

“…three-dimensional (3D)] designs have demonstrated high rates of long-term survival. 17 However, there is little consensus on which technique demonstrates the highest rate of implant survival and superior patient functioning while achieving the lowest rates of complication and cost.…”

Orthopedics and 3D technology in Turkey: A preliminary report

“…Therefore, custom-made 3D printed acetabular implants were developed to achieve primary implant stability, even in cases of pelvic discontinuity situations. [8][9][10]20] Çıtak et al [8] reported that 3D-printed acetabular components had a 56% complication rate in severe acetabular defects, although it was promising in future revision THA. In contrast, Aprato et al [9] showed encouraging results of the Bespoke acetabular system for Paprosky type 3B acetabular defects and all procedures were rated positively.…”