Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss

Borland, W. Steven; Bhattacharya, Rajarshi; Holland, J; Brewster, N

doi:10.3109/17453674.2012.718518

Cited by 73 publications

(57 citation statements)

References 32 publications

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“…Metal augments try to create peripheral acetabular containment to facilitate graft impaction [16]. Different series have been recently published reporting good preliminary results [3,13,15,16].…”

Section: Discussionmentioning

confidence: 99%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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Background Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown.Questions/purposes We therefore evaluated patients undergoing acetabular revision surgery using IBG and a cemented cup in large bone defects to determine (1) the frequency with which the hip center could be restored in hips with Paprosky 3A and 3B defects and in hips with or without the use of metallic mesh during surgery; (2) survivorship of IBG acetabular-revision reconstructions in patients with severe Paprosky 3A and 3B defects; and (3) risk factors for failure of the reconstruction, including the use of mesh and defect severity (3A versus 3B). Methods Between 1997 and 2009, we performed 226 acetabular revisions using IBG. During that time, indications for using IBG in this setting included Paprosky 3A and 3B defects without pelvic discontinuity. Of these, 204 (90.2%) were available for followup at a minimum of 5 years (mean, 10 years; range, 5-17 years). There were 100 hips with an intraoperative bone defect of Paprosky 3A and 104 with a 3B. Medial or rim acetabular uncontained defects were treated with medial and/or lateral metallic mesh in 142 hips. We determined the postoperative radiological cup position and acetabular reconstruction of the hip center according to Ranawat in both groups. We assessed the appearance of cup loosening and the possible risk factors with regression analysis. Results Mean postoperative acetabular abduction angle and vertical, horizontal, and hip rotation center distances improved (p \ 0.001 in all parameters). Nine hips showed radiological loosening in the group with bone defect 3A and 16 in Group 3B. The survival rate for loosening at 15 years was 83% (95% confidence interval [CI], 71%-95%) for Group 3A and 73% (95% CI, 60%-84%) for Group 3B (p = 0.04). The survivorship for loosening when using mesh or not at 15 years was: no mesh 89% (95% CI, 74%-99%), medial mesh 85% (95% CI, 72%-97%), lateral mesh 80% (95% CI, 67%-91%), and medial and lateral meshes

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Section: Discussionmentioning

confidence: 99%

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

García-Rey¹,

Madero

García-Cimbrelo³

2015

Clinical Orthopaedics &Amp; Related Research

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“…Iwase et al showed that acetabular IBG reconstruction was indicated in cases in which the maximum acetabular defect distance was within 20 mm and the problem was a simple wall defect [12]. They suggested using a reinforcement ring or a cage with bulk allograft [13] [14] or porous trabecular metal auguments [6] [7] with IBG for cases with >20 mm maximum acetabular defect distance combined with multiple segmental wall defects [12]. Van Haaren et al…”

Section: Discussionmentioning

confidence: 99%

“…A combination of these methods may also be considered. The use of morselized cancellous bone graft and a cementless porous coated acetabular component is also a well-established acetabular revision surgical technique in the presence of bone deficiency [6] [7]. These options are often inadequate, however, when the acetabular bone loss is great.…”

Section: Introductionmentioning

confidence: 99%

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Taniguchi¹,

Sonekatsu²,

Taniguchi³

et al. 2017

OJO

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Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

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“…3 Possible options for management of these defects include jumbosized cups, cup-cage constructs, and trabecular metal augments. [3][4][5] Unfortunately, studies have shown revision…”

Section: Introductionmentioning

confidence: 99%

Novel Use of a Trabecular Metal Augment in a Severe Acetabular Defect

Bolognesi¹,

Scott²

2017

The Duke Orthopaedic Journal

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Many total hip arthroplasties are complicated by severe acetabular bone loss, limiting reconstruction options. This case report details the use of a 54-mm trabecular metal straight buttress and press-fit jumbo cup to reconstruct an especially large superior and medial defect (Paprosky type IIIB). Specifically, the large defect was reconstructed by placing the augment superior-medially in the acetabular defect instead of simply superiorly and attached to the iliac wing as it is more commonly employed. To our knowledge, there has been no reported use of a similar augment to fill such a defect in this way. This technique represents a promising potential option for reconstruction of especially large superior and medial acetabular defects

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Use of porous trabecular metal augments with impaction bone grafting in management of acetabular bone loss

Cited by 73 publications

References 32 publications

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

THA Revisions Using Impaction Allografting With Mesh Is Durable for Medial but Not Lateral Acetabular Defects

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Novel Use of a Trabecular Metal Augment in a Severe Acetabular Defect

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