Article

Managing bone loss in acetabular revision

University of Iowa, Iowa City, Iowa, United States
Instructional course lectures 02/2006; 55(7):287-97.
Source: PubMed

ABSTRACT

The management of bone loss encountered during acetabular revision remains challenging. In order to obtain a successful surgical result, preoperative planning is required to estimate the severity and location of bone defects. Most acetabular revisions can be treated with the use of a cementless hemispherical component. However, a successful surgical reconstruction requires component stability. Depending on the degree of bone loss, the surgical reconstruction may require the use of cancellous or structural bone graft, acetabular augmentation, an acetabular cage, a custom implant, or an acetabular transplant.

0 Followers
 · 
8 Reads
    • "It has been shown that the acetabular allografts unite at an average of 11 months (range, 6-16 months).14 Paprosky6 reported a success rate of 82% in cases where a cage was used along with total acetabular allograft as compared with 38% in cases without the use of cage. Garbuz15 also advocated the use of cage along with acetabular allograft for better results. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The most challenging aspect of an acetabular revision is the management of severe bone loss, which compromises implant fixation and stability. We present a case of failed acetabular revision with extensive bone loss (Paprosky Type 3b) in a 50-year-old woman with rheumatoid arthritis, which was treated using total acetabular allograft. At a follow-up of 1 year and 3 months, the allograft had united with the host bone. This is the first report of the use of a total acetabular allograft for revision total hip arthroplasty in India. The total acetabular allograft allows the placement of the component closer to the normal hip center, provides initial stability for the acetabular component, and restores bone stock to the host pelvis.
    No preview · Article · Apr 2009 · Indian Journal of Orthopaedics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Total hip arthroplasty is the most successful orthopedic procedure and the frequency of use of revision components has grown exponentially. The increased number of revisions results from the longer life expectancy of the population and the greater frequency of the hip arthroplasty indication among young patients. The purpose of this study is to evaluate the functional results of patients subjected to revision of the acetabular component using reinforcement rings. The study included patients with a diagnosis of septic or aseptic prosthetic loosening and sequelae of acetabular fractures between January 2007 and November 2009 in whom a reinforcement ring was used. The WOMAC scale was used for the functional evaluation. According to the WOMAC scale, the patient functionality results showed a mean preoperative score of 41.89 and a mean postoperative score of 74.26, which represented an improvement of 33.11 points in the median of patients subjected to the surgical intervention, with a statistically significant difference (p = 0.036). This study shows an improvement in the functionality of the patients subjected to surgery with a reinforcement ring, as, first and foremost, a statistically significant difference was seen between the preoperative and postoperative values and, secondly, there are papers published in the literature showing that a difference of more than 12 points between the preoperative and postoperative scores in the WOMAC scale indicates a significant clinical improvement of patients. Patients subjected to acetabular revision with a reinforcement ring together with cemented polyethylene have an improved quality of life after the surgical intervention.
    Full-text · Article · Jul 2010
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund: Beim Hüftpfannenwechsel werden heute überwiegend zementfreie Implantate verwendet. In der vorliegenden Arbeit wird erstmals über die Ergebnisse der Anwendung der Hüftpfanne Plasmacup der Fa. Aesculap bei dieser Indikation berichtet. Methode: Retrospektiv wurden 72 zementfreie Hüftpfannenwechsel aus dem Zeitraum vom 1. Januar 1996 bis 31. Dezember 2003 erfaßt, welche im Kreiskrankenhaus Frankenberg unter Verwendung der drei sich in den wesentlichen Parametern gleichenden Plasmacup vom Typ P (33 Fälle, 46%), Typ S (17 Fälle, 24%) und Typ SC (22 Fälle, 30%) vorgenommen wurden. Die mittlere Nachbeobachtungszeit betrug 7 Jahre (0,5 bis 12,5 Jahre). Das Durchschnittsalter der Patienten bei der Implantation war 65,4 Jahre. Die Acetabulumdefekte wurden anhand der präoperativen Bilder nach Paprosky eingeteilt. Es fanden sich 9 Paprosky Typ 1, 40 Typ 2, 10 Typ 3a und 1 Typ 3b. In 20% wurde zusätzlich autogener, in 10% allogener und in 1% xenogener Knochenersatz verwendet. 90% der Typen S und SC erhielten eine zusätzliche Schraubenfixierung. Bei 68 Patienten (94%) konnte das Schicksal der Pfanne verfolgt werden. 14 Patienten (19%) waren verstorben, hier wurden die Angehörigen oder der Hausarzt befragt. 44 Patienten (61%) konnten persönlich untersucht werden und bei 10 (14%) erfolgte ein standardisiertes Telefoninterview. Die verfügbaren Röntgenaufnahmen (336 Aufnahmen, davon 74 Hüft- und 262 Beckenaufnahmen) wurden hinsichtlich Osteointegration der Pfannen sowie Osteolysen in den DeLee Zonen beurteilt. Die Entwicklung einer Pfannenmigration wurde mit Hilfe des computergestützten Programmes Wristing überprüft, welches die gleichseitige Tränenfigur als wesentlichen Referenzpunkt benutzt. Zur Bewertung des klinischen Befundes wurde der Harris Hip Score und der WOMAC Score erhoben. Ergebnisse: Der Harris Hip Score betrug bei der Nachuntersuchung im Median 88,5 Punkte und der WOMAC Score 18,5 Punkte. 93% der nachuntersuchten Patienten zeigten sich mit dem Ergebnis der Wechseloperation zufrieden. Eine der Hüftpfannen musste wegen einer Infektion entfernt werden. Weitere Pfannenlockerungen traten im Nachuntersuchungszeitraum nicht auf. Röntgenologische Hinweise auf eine Pfannenlockerung in Form von zunehmenden strahlentransparenten Säumen fanden sich nicht. Postoperativ in 24% der Fälle vorhandene Säume bildeten sich zurück. Die zusätzliche Verschraubung der Pfanne oder die Verwendung von Knochentransplantaten beeinflusste das Ergebnis nicht. Am Gesamtkollektiv der Pfannen war keine signifikante Migration in longitudinaler oder transversaler Richtung festzustellen. Allerdings vergrößerte sich der Inklinationswinkel um 3,5° signifikant (p < 0,001). Schlussfolgerung: Die Plasmacup erscheint für zementfreie Wechseloperationen geeignet, die Ergebnisse der Studie sind, wie der Literaturvergleich zeigt, mit denen gut untersuchter ähnlicher Pfannen anderer Hersteller vergleichbar. Die Pfanne zeigt langfristig eine stabile Osteointegration nach Implantation auch bei größeren Knochendefekten im Acetabulum. Background: A cementless component is currently used in most acetabular revisions. The present study gives the first report about the application of the Plasmacup from Aesculap, which is a hemispherical porous socket as a revision component. Methods: 72 cementless cup revisions were performed in the Frankenberg district hospital between 1st January 1996 and 31st December using one of three types of Plasmacup, each having identical main features Type P was used in 33 cases (46%), type S in 17 cases (24%) and type SC in 22 cases (30%). The mean follow up period was 7 years (range 0.5 – 12.5 years). The mean age of the patients at the index operation was 65.4 years. The pre-operative X-rays were used for grading the bone defects according to the Paprosky score. There were 9 Paprosky type 1, 40 type 2, 10 type 3a and 1 type 3b defects. Autografts were used in 20%, allografts in 10% and xenografts in 1% of the revisions. The fate of 68 cups (94%) could be followed up. 44 (41%) patients could be examined in person, 10 (14%) were interviewed by telephone by the means of a standardised questionnaire, 14 patients (19%) died, and therefore the relatives or the GP were interviewed. 336 X-rays were evaluable (74 of the hip and 262 of the pelvis) and analysed in respect of osseointegration of the cups and osteolysis according to the DeLee zones. Cup migration was checked with the help of the computer-program Wristing, with the teardrop as main reference point. For the clinical evaluation the Harris Hip Score and the WOMAC score were used. Results: At the final examination the mean Harris Hip Score was 88.5 points and the mean WOMAC score 18.5 points. 93% of the personally examined patients expressed their satisfaction with the result of the operation. During the follow up period no aseptic loosening could be observed and only one cup had to be removed due to infection. Regarding the acetabular implants as an entirety, no significant migration could be observed in the longitudinal and the transversal direction. The inclination showed a significant alteration of 3.5° (p < 0,001). There was no progressive radiolucency in the aseptic cases and the postoperative radiolucency which occured in 24% of the cups decreased. Neither the application of screws (done in 90% of type S and SC) nor grafting influenced the outcome. Conclusion: The Plasmacup is suitable for cementless cup revision. It achieves results comparable to cups from other manufacturers which have been well examined and described in the literature. A solid osseointegration can even be expected in the event of major bone loss.
    Preview · Article ·
Show more