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acetabular bone defect

Keizo Wada, Tomohiro Goto, Tomoya Takasago, Takahiko Tsutsui, Koichi Sairyo
Case: A 79-year-old woman with an extreme bone defect after failed cementless total hip arthroplasty underwent revision arthroplasty with a novel technique that involved cutting the anterior iliac bone and sliding it distally to reconstruct the anterior acetabular wall. A three-dimensional printed bone model enabled understanding the details of the bone defect. The clinical outcome at 3 years after surgery was favorable. Conclusion: The advantages of this technique are twofold, namely, stable fixation of the cup sandwiched between the anterior and posterior walls and reconstruction of the anterior wall using living bone, which allows bone ingrowth into the cup...
2018: Case Reports in Orthopedics
Giuseppe Marongiu, Daniele Podda, Michele Mastio, Antonio Capone
PURPOSE: The management of severe acetabular bone deficiency and a stable femoral stem can be a challenging problem in revision hip surgery. Replacement of both the acetabular and femoral component in elderly patients can increase perioperative risks without the certainty of a better functional outcome. We report the long-term outcome of reinforcement rings in isolated acetabular revision to determine whether this procedure allows hip function restoration and implant longevity. METHODS: A retrospective study was conducted to evaluate the long-term results of isolated acetabular revision in thirty patients with a mean age of 70...
September 25, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Baochun Zhou, Yixin Zhou, Dejin Yang, Hao Tang, Hongyi Shao, Yong Huang
BACKGROUND: Reconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques. METHODS: A retrospective review was conducted on 74 consecutive THAs revised using metal augments with a cementless hemispherical cup and 77 consecutive THAs revised using the jumbo cup, all with a minimum 2-year follow-up...
August 29, 2018: Journal of Arthroplasty
Yuta Sakemi, Keisuke Komiyama, Kensei Yoshimoto, Kyohei Shiomoto, Miho Iwamoto, Yasuharu Nakashima
BACKGROUND: Due to anterior bone defects, high and/or posterior placement of an acetabular cup is often required to achieve sufficient coverage in patients with hip dysplasia. We examined whether posterior cup placement affected the postoperative range of motion (ROM) in primary total hip arthroplasty (THA). METHODS: Using computer software, bone coverage and ROM were examined in 32 patients with unilateral osteoarthritis of the hip with Crowe type II or III hip dysplasia...
September 19, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Emmanuel Gibon, Luc Kerboull, Jean-Pierre Courpied, Moussa Hamadouche
Acetabular revisions with severe bone defects can be challenging procedures. Several grading systems have been set into place to help the surgeon adequately gauge the degree of bone loss within the acetabulum. Internationally innovative research in orthopedics and bio-engineering has helped with progression of successful techniques and rings to re-establish the normal anatomy of the hip. The purpose of this review is to evaluate the outcomes of the different acetabular reinforcement rings in the setting of severe acetabular defects...
September 13, 2018: International Orthopaedics
Jeffrey B Stambough, Jacob A Haynes, Robert L Barrack, Ryan M Nunley
Tibial bone loss is a common scenario encountered during revision total knee arthroplasty. Reconstructive options depend on the amount and location of bone loss, but few good solutions exist to address large, uncontained tibial defects where cortical support is lost in the metadiaphyseal region. We describe a novel technique using acetabular augments to buttress a revision tibial component and recreate a hemiplateau during tibial revision total knee arthroplasty. In selected scenarios, this construct can create a biomechanically friendlier surface onto which to support the tibial tray and a less expensive option when compared to traditional stacked augments or cones...
September 2018: Arthroplasty Today
Andrzej Pozowski, Mateusz Kowal, Patryk Pozowski, Małgorzata Paprocka-Borowicz
BACKGROUND: In spite of many decades of experience and huge data resources to evaluate the results of increasingly difficult and extensive acetabulum revision operations, it is not possible to obtain fully satisfactory results. This article presents the indications for use, surgical technique, and distant and intermediate-range results in the operation of replacing a loosened acetabular component of an endoprosthesis with accompanying extensive cavitary or segmental floor defects. MATERIAL AND METHODS: A retrospective evaluation was performed on 65 hips in 55 patients, including bila-teral procedures in 8 women and 2 men, operated on between 1994 and 2012...
April 16, 2018: Ortopedia, Traumatologia, Rehabilitacja
Henri Migaud, Harold Common, Julien Girard, Denis Huten, Sophie Putman
Bone defects during acetabular revision of total hip arthroplasty raise a problem of primary fixation and of durable reconstruction. Bone graft with direct cemented fixation or in a reinforcement cage was long considered to be the gold standard; however, failures were reported after 10 years' follow-up, especially in segmental defect of the roof or pelvic discontinuity. In such cases, metallic materials were proposed, to ensure primary fixation by a roughness effect with added screws, and especially to avoid failure due to bone resorption in the medium term...
August 20, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
X-D Wu, W Xu, M Tian, Q Cheng, W Huang
Previous studies have demonstrated that revision of total hip arthroplasty consumes considerably more resources than the primary procedure. Worse, patients who need revision procedures are more likely to have radiographic evidence of acetabular and femoral bone loss than those undergone primary total hip arthroplasty. Many techniques have been introduced to manage different conditions of acetabular deficiencies. We describe a rare case of a 67-year-old man with severe acetabular bone loss, which was caused by a long-term loose acetabular component and was successfully managed by cup-on-cup technique...
September 2018: Annals of the Royal College of Surgeons of England
K K Eachempati, R Malhotra, S Pichai, A V G Reddy, A K Podhili Subramani, D Gautam, V R Bollavaram, N P Sheth
Aims: The advent of trabecular metal (TM) augments has revolutionized the management of severe bone defects during acetabular reconstruction. The purpose of this study was to evaluate patients undergoing revision total hip arthroplasty (THA) with the use of TM augments for reconstruction of Paprosky IIIA and IIIB defects. Patients and Methods: A retrospective study was conducted at four centres between August 2008 and January 2015. Patients treated with TM augments and TM shell for a Paprosky grade IIIA or IIIB defect, in the absence of pelvic discontinuity, and who underwent revision hip arthroplasty with the use of TM augments were included in the study...
July 2018: Bone & Joint Journal
Tatsuya Tamaki, Taishi Ninomiya, Kurato Jonishi, Yoko Miura, Kazuhiro Oinuma, Hideaki Shiratsuchi
BACKGROUND: The direct anterior approach has gained popularity in total hip arthroplasty (THA) over the past decade. However, there are few reports that describe the use of this approach for cases of complex revision. The purpose of this study was to report the surgical procedure and early clinical results of acetabular revision in the presence of bone defects using a Kerboull-type reinforcement device through the direct anterior approach. METHODS: Eleven patients who had undergone acetabular reconstruction using a Kerboull-type reinforcement device for aseptic or septic loosening bone defects were enrolled...
May 2018: Journal of Orthopaedic Surgery
N A Beckmann, R G Bitsch, M Gondan, M Schonhoff, S Jaeger
Objectives: In order to address acetabular defects, porous metal revision acetabular components and augments have been developed, which require fixation to each other. The fixation technique that results in the smallest relative movement between the components, as well as its influence on the primary stability with the host bone, have not previously been determined. Methods: A total of 18 composite hemipelvises with a Paprosky IIB defect were implanted using a porous titanium 56 mm multihole acetabular component and 1 cm augment...
April 2018: Bone & Joint Research
Alexander Arzeno, Tim Wang, James I Huddleston
Revision hip arthroplasty in the setting of periacetabular bone loss presents a significant challenge, as options for restoring bone loss are limited. Recombinant human bone morphogenetic protein-2 may offer a solution by promoting bone growth to restore bone stock before implant reimplantation. Here we present a case of a patient with a periprosthetic acetabulum fracture, resulting in pelvic discontinuity as the result of significant periacetabular bone loss. Using a staged approach, periacetabular bone stock was nearly entirely reconstituted using recombinant BMPs and allograft, which resulted in stable fixation, but with abundant heterotopic bone formation...
June 2018: Arthroplasty Today
Joong-Myung Lee, Tae-Ho Kim
The rate of acetabular cup revision arthroplasty is gradually rising along with an increased risk of osteolysis and prosthesis loosening over time and an increase in life expectancy. The goals of revision total hip arthroplasty are: i) implant stability through reconstruction of large bone defects, ii) restoration of range of motion and biomechanics of the hip joint, and iii) normalization of uneven limb lengths. In acetabular cup revision arthroplasty, stable fixation of acetabular components is difficult in the presence of severe bone loss (e...
June 2018: Hip & Pelvis
Shijiu Yin, Hang Zhong, Ruibo Li, Ping Mou, Jing Yang
Objective: To explore the surgical technique and effectiveness of autologous femoral head bone graft in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) with acetabular bone defect. Methods: Between July 2012 and September 2015, 12 cases (12 hips) of Crowe type Ⅲ DDH with acetabular bone defect were included. Of the 12 patients, 2 were male and 10 were female, with an average age of 54.3 years (range, 37-75 years). The Harris score before operation was 41...
January 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
David C Kieser, Ramez Ailabouni, Sandra C J Kieser, Michael C Wyatt, Paul C Armour, Mark H Coates, Gary J Hooper
INTRODUCTION: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. METHODS: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
A Torres-Campos, J Albareda Albareda, B Seral García, N Blanco Rubio, J Gómez Vallejo, L Ezquerra Herrando
INTRODUCTION AND OBJECTIVES: Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. MATERIAL AND METHODS: Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up...
May 15, 2018: Revista Española de Cirugía Ortopédica y Traumatología
Stanislav Bondarenko, Ninel Dedukh, Volodymyr Filipenko, Mandus Akonjom, Ahmed Amine Badnaoui, Ran Schwarzkopf
BACKGROUND: There is a lack of comparative data on osseointegration (BIC) of acetabular cup surfaces in hip arthroplasty in both normal bone mineral density and in conditions of osteoporosis. AIM: To compare osseointegration of acetabular implants with various types of surfaces in an animal model with normal and osteoporotic bone tissue. MATERIAL AND METHODS: The study was performed on 60 rats. To simulate osteoporosis ovariectomy was performed in 30 animals...
May 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Hazem A H Hosny, Ahmed El-Bakoury, Sreebala C M Srinivasan, Rathan Yarlagadda, Jonathan Keenan
BACKGROUND: The use of highly porous acetabular components has shown to produce good results in revision acetabular surgery. Their surface characteristics enhance initial fixation and bone ingrowth which are prerequisites for adequate osseointegration. The purpose of this study is to analyze the mid-term to long-term survival, clinical and radiological outcomes using the Tritanium cup (Stryker, Mahwah, NJ) in revision hip surgery. METHODS: This is a retrospective review of all patients who underwent acetabular revision surgery using "Tritanium revision cup" between April 2007 and November 2010 at our institution...
August 2018: Journal of Arthroplasty
Dahui Wang, Yifeng Lin, Lian Chen, Yueqiang Mo, Peng Huang, Ruixue Ma
Developmental dysplasia of the hip (DDH) is one of the most common diseases encountered in pediatric orthopedic departments. Current treatment strategies seek to improve acetabular coverage, the principal defect of acetabular dysplasia, but are not very successful. We developed a guided bone regeneration (GBR) strategy to improve acetabular coverage via bone tissue engineering (BTE). Poly- dl -lactide (PDLLA) membranes were seeded with bone marrow mesenchymal stem cells (BMSCs) to form a BTE complex, which was then implanted into the superior margin of the acetabulum in a rabbit DDH model...
March 27, 2018: Oncotarget
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