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acetabular bone defect

Jaime J Morales De Cano, Llorenç Guillamet, Arturo Perez Pons
Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC)...
January 2019: Acta Ortopedica Brasileira
Daniele Munegato, Marco Bigoni, Romeo Sotiri, Antongiulio Bruschetta, Robert J Omeljaniuk, Marco Turati, Rossi Andrea, Giovanni Zatti
INTRODUCTION: This study evaluates mid-term results of acetabular revision using a hemispherical acetabular cup in Trabecular Titanium with a cage construct. METHODS: We reviewed 36 acetabular revisions performed with the Delta Revision TT cup in 34 patients (mean age = 75, range: 45-92 years). Acetabular defect types (Paprosky classification) included (1) 2B ( n = 5), (2) 2C ( n = 7), (3) 3A ( n = 15), and (4) 3B ( n = 9). Morcellised bone allografts were used in 24 cases, and synthetic bone used in 11...
November 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Mattia Loppini, Paolo Schiavi, Antonello Della Rocca, Francesco Traverso, Federico Della Rocca, Giuseppe Mazziotta, Franco Astore, Guido Grappiolo
INTRODUCTION: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. METHODS: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015...
November 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Federico De Meo, Giorgio Cacciola, Vittorio Bellotti, Antongiolio Bruschetta, Pietro Cavaliere
INTRODUCTION: Severe acetabular bone loss during revision hip arthroplasty can be restored with different surgical techniques. Best results have been observed using porous tantalum cementless cups. Trabecular Titanium (TT) cups were designed to reproduce the structure, mechanical and biological characteristics of trabecular bone. Few clinical studies have been published with these cups. The aim of this study is to evaluate the clinical and radiological outcome of patients with large acetabular defects (Paprosky IIb or higher) revised using TT cups...
November 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Alessandro Aprato, Matteo Olivero, Luigi Branca Vergano, Alessandro Massè
BACKGROUND AND AIM OF THE WORK: To investigate the clinical, radiological and functional outcomes of acetabular revisions with acetabular reinforcement rings and cages. METHODS: A comprehensive literature study of international databases was performed. Inclusion criteria were cementless revisions, use of reinforcement rings, radiological and clinical follow-up, availability of full text in English, publication between January 1990 and July 2018. In a second further analysis, we selected only studies describing patients with more severe acetabular defects (AAOS 3, AAOS 4, Paprosky III)...
January 10, 2019: Acta Bio-medica: Atenei Parmensis
Thomas P Moser, Marta Onate, Katia Achour, Véronique Freire
OBJECTIVES: To evaluate lesion filling and other factors that could affect the clinical outcomes of cementoplasty for pelvic bone metastases. METHODS: We retrospectively reviewed the files of 40 patients treated for 44 pelvic bone metastases, collected the parameters related to patients (pain relief evaluated on a visual analog scale, subsequent fractures, and need for surgery), lesions (size, cortical breach score, fracture, soft-tissue extension), and cementoplasty procedures (number of needles, volume of cement, percentage of lesion filling, cement leaks, residual acetabular roof defect), and performed a statistical analysis...
February 2, 2019: Skeletal Radiology
Thipachart Punyaratabandhu, Peter C Liacouras, Sutipat Pairojboriboon
BACKGROUND: Three Dimensional (3D) printed models can aid in effective pre-operative planning by defining the geometry of tumor mass, bone loss, and nearby vessels to help determine the most accurate osteotomy site and the most appropriate prosthesis, especially in the case of complex acetabular deficiency, resulting in decreased operative time and decreased blood loss. METHODS: Four complicated cases were selected, reconstructed and printed. These 4 cases were divided in 3 groups of 3D printed models...
November 26, 2018: 3D printing in medicine
T Chompoosang, R D'Apolito, C Lacagnina, G Peretti, L Zagra
Rapidly progressive osteoarthritis (RPOA) is an uncommon subset of osteoarthritis (OA) characterized by rapid joint degeneration and destruction. The treatment of choice for these patients has traditionally been total hip arthroplasty (THA) because nonoperative treatments modalities are not effective. RPOA can lead to acetabular bone loss and consequently intraoperative technical difficulties making joint reconstruction in such patients a challenge for the surgeon. The purpose of this study was to determine the clinical and radiological results of patients suffering from RPOA and treated with hybrid or cementless THA at a single institution...
November 2018: Journal of Biological Regulators and Homeostatic Agents
E Colo, L A M Leenders, W H C Rijnen, B W Schreurs, G Hannink
AIMS: The aim of this study was to analyze the effect of a lateral rim mesh on the survival of primary total hip arthroplasty (THA) in young patients, aged 50 years or younger. PATIENTS AND METHODS: We compared a study group of 235 patients (257 hips) who received a primary THA with the use of impaction bone grafting (IBG) with an additional lateral rim mesh with a group of 306 patients (343 hips) who received IBG in the absence of a lateral rim mesh during the same period from 1988 to 2015...
January 2019: Bone & Joint Journal
Daishi Hamada, Toshiharu Mori, Manabu Tsukamoto, Yoshiaki Yamanaka, Soshi Uchida, Akinori Sakai
We report a case of rapidly progressive osteolysis and a very large cystic lesion that destroyed the inner table of the iliac bone following cementless total hip arthroplasty (THA). A 59-year-old female patient developed left hip pain at 11 years after THA. Osteolysis surrounding the acetabular cup was pointed out. She was brought to our hospital by ambulance due to severe left hip pain at 12 years after THA. Computed tomography (CT) showed that a cystic lesion in the pelvic cavity had destroyed the inner table of the iliac bone...
2018: Journal of UOEH
Tobias Freitag, Martin Faschingbauer, Bernd Lutz, Ralf Bieger, Heiko Reichel
Due to the increasing number of primary hip arthroplasty procedures, revision surgery will be an increasing challenge. The surgeon is frequently confronted with important acetabular defects. Careful preoperative planning is essential to achieve functional and long-term success. Treatment options include porous hemispheric cups, porous metal augments, oblong cups, cemented implants, rings, allografts, patient specific implants and component combinations. In addition to large hemispherical cups, modular porous metal revision systems are increasingly being used to treat severe acetabular bone loss...
December 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Paul Walbron, Florence Müller, Laurence Mainard-Simard, Amandine Luc, Pierre Journeau
Quality of spontaneous amelioration of residual developmental dysplasia of the hip (DDH) is nowadays not possible to predict. Normal age-related values of the osseous acetabular index (OAI), cartilaginous acetabular index and labral acetabular index have been established on MRI. In this study, MRI of dysplastic hips has been evaluated, and further osseous acetabular maturation was followed-up over time on pelvic radiography to find a correlation between MRI findings and radiological evolution. This is a retrospective single-centre study...
December 13, 2018: Journal of Pediatric Orthopedics. Part B
Philip P Roessler, Max Jaenisch, Manuel Kuhlmann, Miriam Wacker, P Johannes Wagenhäuser, Sascha Gravius, Dieter C Wirtz
PURPOSE: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity...
December 11, 2018: International Orthopaedics
Jun Fu, Ming Ni, Jiying Chen, Xiang Li, Wei Chai, Libo Hao, Guoqiang Zhang, Yonggang Zhou
Purpose: The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment and TM augment and further to analyze the stress distribution and clinical safety of augments, screws, and bones. Methods: The FEA model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment was established by the CT data of a patient with Paprosky IIIA defect. The von Mises stresses of augments, screws, and bones were analyzed by a single-legged stance loading applied in 3 increments (500 N, 2000 N, and 3000 N)...
2018: BioMed Research International
Gennadiy M Kavalerskiy, Valeriy Y Murylev, Yaroslav A Rukin, Pavel M Elizarov, Alexey V Lychagin, Evgeniya Y Tselisheva
Background: Careful preoperative planning in revision cases with complex acetabular defects is crucial for optimal surgery outcome. However, in many cases, computed tomography (CT) scans cannot give a clear understanding of the pelvic destruction. Three-dimensional (3D) models-based on CT data can help surgeon in planning of complex acetabular reconstruction. Materials and Methods: We used 3D plaster pelvic models in 17 revision cases. There were 5 patients with Paprosky II C acetabular defects, 2 patients with Paprosky IIIA defects, and 10 patients with Paprosky IIIB defects (3 patients among them with pelvic discontinuity)...
November 2018: Indian Journal of Orthopaedics
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
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