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acetabular bone defect

Lucian B Solomon, John M Abrahams, Stuart A Callary, Donald W Howie
BACKGROUND: The acetabular components used in revision total hip arthroplasty (THA) to treat severe acetabular bone defects have high rates of re-revision at mid to long-term follow-up. Early translation of acetabular components used in revision THA is a good predictor of later loosening, and radiostereometric analysis (RSA) is the most sensitive method to measure migration. The objectives of the present study were to use RSA to compare the migration of the porous tantalum acetabular components used to treat severe bone defects with the previously established acceptable proximal translation threshold of ≤1 mm within 2 years, and to determine the effect on migration of the addition of inferior screws through the component into the ischium or pubis...
November 21, 2018: Journal of Bone and Joint Surgery. American Volume
J T Munro, J S Millar, J W Fernandez, C G Walker, D W Howie, V B Shim
AIMS: Osteolysis, secondary to local and systemic physiological effects, is a major challenge in total hip arthroplasty (THA). While osteolytic defects are commonly observed in long-term follow-up, how such lesions alter the distribution of stress is unclear. The aim of this study was to quantitatively describe the biomechanical implication of such lesions by performing subject-specific finite-element (FE) analysis on patients with osteolysis after THA. PATIENTS AND METHODS: A total of 22 hemipelvis FE models were constructed in order to assess the transfer of load in 11 patients with osteolysis around the acetabular component of a THA during slow walking and a fall onto the side...
November 2018: Bone & Joint Journal
C Hipfl, V Janz, J Löchel, C Perka, G I Wassilew
AIMS: Severe acetabular bone loss and pelvic discontinuity (PD) present particular challenges in revision total hip arthroplasty. To deal with such complex situations, cup-cage reconstruction has emerged as an option for treating this situation. We aimed to examine our success in using this technique for these anatomical problems. PATIENTS AND METHODS: We undertook a retrospective, single-centre series of 35 hips in 34 patients (seven male, 27 female) treated with a cup-cage construct using a trabecular metal shell in conjunction with a titanium cage, for severe acetabular bone loss between 2011 and 2015...
November 2018: Bone & Joint Journal
C M Green, S C Buckley, A J Hamer, R M Kerry, T P Harrison
AIMS: The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. PATIENTS AND METHODS: Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component...
November 2018: Bone & Joint Journal
Chih-Hsiang Chang, Chih-Chien Hu, Chun-Chieh Chen, John Mahajan, Yuhan Chang, Hsin-Nung Shih, Young-Min Kwon
There are several surgical options for addressing Paprosky type III acetabular defects during revision total hip arthroplasty. In physiologically young and active patients, using structural bone graft to restore bone defects and provide adequate initial support for the revision acetabular component is one such option. This study reports the mid-term results of using a structural allograft accompanied by a trabecular metal-coated hemispherical cup for Paprosky type III defects. A retrospective analysis was performed of the data collected for 20 consecutive hips in 20 patients (mean age, 56...
November 1, 2018: Orthopedics
Georg Hettich, Ronja A Schierjott, Heiko Ramm, Heiko Graichen, Volkmar Jansson, Maximilian Rudert, Francesco Traina, Thomas M Grupp
The objective of the study was to suggest a novel quantitative assessment of acetabular bone defects based on a statistical shape model, validate the method, and present preliminary results. Two exemplary CT-data sets with acetabular bone defects were segmented to obtain a solid model of each defect pelvis. The pathological areas around the acetabulum were excluded and a statistical shape model was fitted to the remaining healthy bone structures. The excluded areas were extrapolated such that a solid model of the native pelvis per specimen resulted (i...
October 22, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Zhi-Wei Kang, Yao-Hui Zhang, Zi-Quan Yang
As a mature technology gradually, the total hip arthroplasty has been known and conducted by more and more orthopedic surgeons. However, it also increased the number of hip revisions. The reasons for revision of hip mainly include: unstable, infection, aseptic loosening prosthesis, prosthesis peripheral fracture, liner wear and so on, and the acetabulum bone defect and the choice of acetabular prosthesis have been perplexing surgeons. In this paper, we summarise classification and reconstruction of acetabulum bone defect in hip revision oprations, compare the advantages and disadvantages of all kinds of classification, on this basis can have more than one bone grafting mode and the choice of the acetabulum prosthesis for reconstruction of acetabulum, then expound the ways of material sources, bone grafting modes and complex acetabulum bone defect reconstruction as well as the choice of the ways of fixed prosthesis, providing the basis for clinical doctors to deal with all kinds of acetabulum bone defect and the choice of the acetabulum prosthesis, guiding patient specific therapy more precisely...
September 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
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
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