Abstract
Background
Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, hip center elevation may occur with use of a jumbo cup owing to reaming superiorly and/or because of the increased diameter of the jumbo cup compared with the native acetabulum.
Questions/purposes
In our jumbo cup revision THAs, we attempted to avoid hip center elevation by placing the inferior edge of the cup at the inferior acetabulum. In this study, we asked (1) how much of an elevation in the hip center is observed radiographically with use of jumbo cups, and (2) how effective was our technique in minimizing hip center elevation during revision THA in clinical practice?
Methods
We retrospectively reviewed radiographic data for all patients, from one surgeon’s practice, who received a jumbo cup (defined as cup size ≥ 66 mm in men, ≥ 62 mm in women) during an acetabular revision between 1998 and 2012 and who had an anatomically placed THA or no THA on the contralateral side (so as to be able to make comparisons); 98 patients were identified and included. The height of the revised hip center was measured relative to the contralateral normal hip. Cup elevation resulting from superior reaming was determined by measuring the distance from the inferior cup edge to the interteardrop line. The mean hip center elevation and cup position relative to the interteardrop line in male and female patients were compared using unpaired t-tests.
Results
Radiographic analysis showed a mean hip center elevation of 11 mm. On average, 1 mm of the measured hip center elevation was the result of cup placement superior to its planned position at the interteardop line.
Conclusions
Our results indicate that revision THA with a jumbo cup is associated with hip center elevation despite placement of the cup at the inferior acetabulum. An increase in femoral head length may be needed to compensate for hip center elevation with use of a jumbo cup.
Level of Evidence
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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One of the authors certifies that he (MDR), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000–USD 100,000, from Smith & Nephew, Memphis, TN, USA.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.
This work was performed at the School of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Nwankwo, C.D., Ries, M.D. Do Jumbo Cups Cause Hip Center Elevation in Revision THA? A Radiographic Evaluation. Clin Orthop Relat Res 472, 2793–2798 (2014). https://doi.org/10.1007/s11999-014-3632-8
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DOI: https://doi.org/10.1007/s11999-014-3632-8