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ABSTRACT: Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages.
We therefore determined (1) revision and overall survival rates, (2) discontinuity healing rate, and (3) Harris hip score (HHS) after treatment of pelvic discontinuity with a custom triflange acetabular component and (4) the cost of this reconstructive operation compared to other constructs.
We retrospectively reviewed 57 patients with pelvic discontinuity treated with revision THA using a custom triflange acetabular component. We reviewed operative reports, radiographs, and clinical data for clinical and radiographic results. We also performed a cost comparison with utilization of other techniques. Minimum followup was 24 months (average, 65 months; range, 24-215 months).
Fifty-six of 57 (98%) were free of revision for aseptic loosening at latest followup. Fifty-four (95%) were free of revision of the triflange component for any reason. Thirty-seven (65%) were free of revision for any reason. Twenty-eight (49%) were free of revision for any reason and free of any component migration and had a healed discontinuity. Forty-six (81%) had a stable triflange component with a healed pelvic discontinuity. Average HHS was 74.8. The costs of the custom triflange implants and a Trabecular Metal cup-cage construct were equivalent: $12,500 and $11,250, respectively.
In this group of patients with osteolytic pelvic discontinuity, triflange implants provided predictable mid-term fixation at a cost equivalent to other treatment methods.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 02/2012; 470(2):428-34. · 2.53 Impact Factor
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ABSTRACT: Osteonecrosis of the femoral head in the setting of alcohol abuse is a potential important cause of symptomatic hip disease in young patients. All cases of uncemented primary total hip arthroplasty (THA) with a primary operative diagnosis of osteonecrosis of the femoral head secondary to alcohol abuse treated at our institution from January 1990 to February 2002 were identified. Twenty-three patients with 28 hips were identified; all patients had advanced disease (subchondral collapse) that was unresponsive to conservative treatment modalities. Within 5 years of index THA, 2 patients were lost to follow-up, and 2 patients died from causes unrelated to their surgery. The remaining 19 patients underwent 24 THAs. Unilateral THA was performed in 14 patients, and bilateral THA was performed in 5 patients. Seventeen men and 2 women with an average age of 41.8 years (range, 30-59 years) at the time of THA were included in the study. The average duration to clinical follow-up was 7.6 years. There was significant improvement in hip pain and hip function scores. Seven THAs were revised at a mean 6.7 years following index THA. Five- and 10-year implant survivorship free of revision was 96% and 64%, respectively (Kaplan-Meier Survivorship Analysis). The continued use of alcohol was associated with a slightly increased risk of failure (61% implant survivorship at 10 years in those with continued alcohol intake vs 75% 10-year survivorship in those without).
Orthopedics 07/2009; 32(6):400. · 2.66 Impact Factor
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ABSTRACT: Hemipelvectomy is a rare procedure performed for tumor resection or trauma. The limb may be spared, and the patients often require extensive rehabilitation. We report the outcome of a total hip arthroplasty (THA) in a patient with endstage hip arthritis in a high dislocated hip contralateral to a remote, traumatic hemipelvectomy. To our knowledge this is the first reported case with mid-term follow-up of a patient undergoing THA for degenerative, traumatic hip dislocation with a contralateral external (limb-sacrificing) hemipelvectomy. Patient history, surgical details, and follow-up 5 years from the index arthroplasty are presented. This case report documents that THA after hemipelvectomy can be a durable procedure, and provide reliable pain relief and improvement in function at intermediate follow-up using good surgical techniques, and with the use of noncemented implants.
Orthopedics 03/2009; 32(2):129. · 2.66 Impact Factor
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ABSTRACT: Loosening of a cemented glenoid component is an important cause of failure in shoulder arthroplasty. This study was developed to examine the outcome of patients managed with a metal-backed, bone-ingrowth glenoid component as an alternative to a cemented component.
The study group included eighty-three total shoulder arthroplasties with a metal-backed, bone-ingrowth glenoid component performed between 1989 and 1994. Seventy-four shoulders had a diagnosis of primary osteoarthritis, and nine shoulders had other diagnoses. All patients were followed radiographically and clinically for a minimum of two years or until the time of revision surgery. Kaplan-Meier survival estimates were performed with revision and/or radiographic failure as the end points.
The mean clinical follow-up was 9.5 years, and the mean radiographic follow-up was 7.1 years. Pain ratings (on a scale of 1 to 5) decreased from a mean of 4.7 preoperatively to 2.0 postoperatively. The mean range of motion in active elevation increased from 102 degrees preoperatively to 135 degrees postoperatively; the mean external rotation increased from 27 degrees to 56 degrees . Glenohumeral joint instability developed in fourteen shoulders. Radiographic changes consistent with glenoid component loosening were present in thirty-three shoulders. Polyethylene wear with metal wear of the glenoid component was noted in twenty-one shoulders, and humeral component loosening was seen in fifteen shoulders. Revision procedures were performed in twenty-six shoulders. There were no identifiable patient, disease, or surgical characteristics associated with failure, either clinically or radiographically. The five-year survival estimate free of revision or radiographic failure was 79.9% (95% confidence interval, 71.6% to 89.3%), and the ten-year survival estimate was 51.9% (95% confidence interval, 41.0% to 65.8%).
The high rate of failure of total shoulder arthroplasties performed with this metal-backed, bone-ingrowth glenoid component raises concerns as to its use, and perhaps the use of other types of metal-backed components, in shoulder arthroplasty, other than for special situations.
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 11/2008; 90(10):2180-8. · 3.27 Impact Factor
