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The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects

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Abstract

Purpose

Revision total hip arthroplasty (THA) is challenging if severe periacetabular bone loss is present. Here we describe a method that uses a customised cage to reconstruct an acetabulum with a massive bone defect.

Methods

Designed with the aid of the rapid prototyping technique, a customised cage with a hook, crest and flange or braids was made, and then utilized to reconstruct severe compromised acetabulum in revision THA since 2001. Twenty-two patients (23 hips) were included in this study. The mean patient age at the time of surgery was 60.9 years (range, 38–80 years). Three hips had massive acetabular bone defects of Paprosky type IIIA and 20 of type IIIB. The Harris hip score was used to evaluate hip function. Radiographs were taken to evaluate loosening of the cage and resorption of allograft bone.

Results

The average follow up was 81.6 ± 24.9 months. The mean Harris hip score improved from 39.6 pre-operatively to 80.9 at the final follow-up. There were no instances of deep infection, severe venous thrombosis, and nerve palsy. One patient who had an intra-operative rupture of the superior acetabular artery was successfully treated using the haemostatic suturing technique. Two patients experienced dislocation at post-operative days four and six, respectively, and both were treated with closed reduction and skin traction for three weeks.

Conclusions

The present study demonstrates that a customised cage may be a promising option for THA revision of severely compromised acetabula. Extended follow-up is necessary to evaluate the long-term performance of this approach.

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References

  1. Regis D, Magnan B, Sandri A, Bartolozzi P (2008) Long-term results of anti-protrusion cage and massive allografts for the management of periprosthetic acetabular bone loss. J Arthroplast 23:826–832. doi:10.1016/j.arth.2007.06.017

    Article  Google Scholar 

  2. Sporer SM, O’Rourke M, Chong P, Paprosky WG (2005) The use of structural distal femoral allografts for acetabular reconstruction. Average ten-year follow-up. J Bone Joint Surg Am 87:760–765. doi:10.2106/JBJS.D.02099

    Article  PubMed  Google Scholar 

  3. Chen AF, Hozack WJ (2014) Component selection in revision total hip arthroplasty. Orthop Clin N Am 45:275–286. doi:10.1016/j.ocl.2014.03.001

    Article  Google Scholar 

  4. Schmolders J, Friedrich MJ, Michel RD, Randau TM, Wimmer MD, Strauss AC, Kohlhof H, Wirtz DC, Gravius S (2015) Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation. Int Orthop 39:1–8

    Article  Google Scholar 

  5. Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross AE (2013) Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss: a mid-term review. Bone Joint J 95-B:166–172. doi:10.1302/0301-620X.95B2.30608

    Article  CAS  PubMed  Google Scholar 

  6. Steno B, Kokavec M, Necas L (2015) Acetabular revision arthroplasty using trabecular titanium implants. Int Orthop 39:389–395

    Article  PubMed  Google Scholar 

  7. Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9:33–44

    Article  CAS  PubMed  Google Scholar 

  8. Li H, Wang L, Mao Y, Wang Y, Dai K, Zhu Z (2013) Revision of complex acetabular defects using cages with the aid of rapid prototyping. J Arthroplast 28:1770–1775. doi:10.1016/j.arth.2012.12.019

    Article  Google Scholar 

  9. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755

    CAS  PubMed  Google Scholar 

  10. Peters CL, Curtain M, Samuelson KM (1995) Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone. J Arthroplast 10:307–312

    Article  CAS  Google Scholar 

  11. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32

  12. Gill TJ, Sledge JB, Muller ME (2000) The management of severe acetabular bone loss using structural allograft and acetabular reinforcement devices. J Arthroplast 15:1–7

    Article  CAS  Google Scholar 

  13. Pazzaglia UE (1990) Pathology of the bone-cement interface in loosening of total hip replacement. Arch Orthop Trauma Surg 109:83–88

    Article  CAS  PubMed  Google Scholar 

  14. Gross AE (1999) Revision arthroplasty of the acetabulum with restoration of bone stock. Clin Orthop Relat Res 369:198–207

  15. Zagorodniy N, Nikolaev I, Nuzhdin V, Kagramanov S (2014) Prospective cohort study of six hundred and sixty four revisions of loose failed acetabular implants. Int Orthop 38:2021–2025

    Article  CAS  PubMed  Google Scholar 

  16. Gross AE (2006) Restoration of acetabular bone loss 2005. J Arthroplast 21:117–120

    Article  Google Scholar 

  17. Sembrano JN, Cheng EY (2008) Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res 466:1657–1665. doi:10.1007/s11999-008-0183-x

    Article  PubMed Central  PubMed  Google Scholar 

  18. Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38:2455–2461

    Article  PubMed  Google Scholar 

  19. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK (2001) Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res 216–227

  20. Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ (2012) Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res 470:428–434. doi:10.1007/s11999-011-2126-1

    Article  PubMed Central  PubMed  Google Scholar 

  21. Wind MA Jr, Swank ML, Sorger JI (2013) Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 36:e260–e265. doi:10.3928/01477447-20130222-11

    Article  PubMed  Google Scholar 

  22. Berasi CC, Berend KR, Adams JB, Ruh EL, Lombardi AV Jr (2015) Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res 473:528–535. doi:10.1007/s11999-014-3969-z

    Article  PubMed  Google Scholar 

  23. Joshi AB, Lee J, Christensen C (2002) Results for a custom acetabular component for acetabular deficiency. J Arthroplast 17:643–648

    Article  Google Scholar 

  24. Holt GE, Dennis DA (2004) Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 429:209–214

  25. DeBoer DK, Christie MJ, Brinson MF, Morrison JC (2007) Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 89:835–840. doi:10.2106/JBJS.F.00313

    Article  PubMed  Google Scholar 

  26. Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168

  27. Nieminen J, Pakarinen TK, Laitinen M (2013) Orthopaedic reconstruction of complex pelvic bone defects. Evaluation of various treatment methods. Scand J Surg SJS Off Organ Finnish Surg Soc Scand Surg Soc 102:36–41

    CAS  Google Scholar 

  28. Lee PT, Raz G, Safir OA, Backstein DJ, Gross AE (2010) Long-term results for minor column allografts in revision hip arthroplasty. Clin Orthop Relat Res 468:3295–3303. doi:10.1007/s11999-010-1591-2

    Article  PubMed Central  PubMed  Google Scholar 

  29. Delloye C, Banse X, Brichard B, Docquier PL, Cornu O (2007) Pelvic reconstruction with a structural pelvic allograft after resection of a malignant bone tumor. J Bone Joint Surg Am 89:579–587. doi:10.2106/JBJS.E.00943

    Article  PubMed  Google Scholar 

  30. Dewal H, Chen F, Su E, Di Cesare PE (2003) Use of structural bone graft with cementless acetabular cups in total hip arthroplasty. J Arthroplast 18:23–28. doi:10.1054/arth.2003.50013

    Article  Google Scholar 

  31. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG (2013) Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 21:128–139. doi:10.5435/JAAOS-21-03-128

    Article  PubMed  Google Scholar 

  32. Schreurs BW, Keurentjes JC, Gardeniers JW, Verdonschot N, Slooff TJ, Veth RP (2009) Acetabular revision with impacted morsellised cancellous bone grafting and a cemented acetabular component: a 20- to 25-year follow-up. J Bone Joint Surg (Br) 91:1148–1153. doi:10.1302/0301-620X.91B9.21750

    Article  CAS  Google Scholar 

  33. Busch VJ, Gardeniers JW, Verdonschot N, Slooff TJ, Schreurs BW (2011) Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg Am 93:367–371. doi:10.2106/JBJS.I.01532

    Article  PubMed  Google Scholar 

  34. Hernigou P, Pariat J, Queinnec S, Homma Y, Lachaniette CHF, Chevallier N, Rouard H (2014) Supercharging irradiated allografts with mesenchymal stem cells improves acetabular bone grafting in revision arthroplasty. Int Orthop 38:1913–1921

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People’s Republic of China

    Yuanqing Mao, Chen Xu, Jiawei Xu, Huiwu Li, Fengxiang Liu, Degang Yu & Zhenan Zhu

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  1. Yuanqing Mao
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  2. Chen Xu
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  3. Jiawei Xu
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  4. Huiwu Li
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  6. Degang Yu
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  7. Zhenan Zhu
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Correspondence to Degang Yu or Zhenan Zhu.

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Mao, Y., Xu, C., Xu, J. et al. The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects. International Orthopaedics (SICOT) 39, 2023–2030 (2015). https://doi.org/10.1007/s00264-015-2965-6

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  • DOI: https://doi.org/10.1007/s00264-015-2965-6

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