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International Orthopaedics

, Volume 42, Issue 8, pp 1811–1818 | Cite as

Clinical and radiological outcomes of trabecular metal systems and antiprotrusion cages in acetabular revision surgery with severe defects: a comparative study

  • Irene Isabel López-Torres
  • Pablo Sanz-Ruíz
  • Coral Sánchez-Pérez
  • Ricardo Andrade-Albarracín
  • Javier Vaquero
Original Paper

Abstract

Introduction

Acetabular revision surgery poses a challenge due to the increased frequency of severe defects and poor quality of the remaining bone. We compare the clinical and radiological outcomes, complications, and survival of two systems commonly used in complex acetabular revisions (AAOS types II, III, and IV): trabecular metal system (TM) and Burch-Schneider antiprotrusion cages (BS).

Methods

Eighty-four patients underwent acetabular revision surgery with TM or BS in our centre between 2008 and 2014. Comparison was made of demographic and clinical characteristics, satisfaction, radiographic parameters, complications, and survival of the implants. A BS was implanted in 30.9% of the patients, while 69.1% received a TM implant. The mean follow-up was 4.77 years.

Results

The BS group required a significantly greater number of constrained implants (p = 0.001) and more walking aids (p = 0.04). The mean satisfaction (p = 0.02) and HHS scores at the end of the follow-up were higher in the TM group (p = 0.003). No differences were observed in the incidence of complications, though the only two cases of implant rupture corresponded to the BS group. The overall survival rate was 88.1% after 7.5 years.

Conclusion

TM implants afforded better clinical outcomes and greater patient satisfaction than antiprotrusion cages in the treatment of severe acetabular defects.

Keywords

Hip arthroplasty Revision Trabecular metal system Antiprotrusion cages 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The present study was carried out following approval by the local Ethics Committee (code: COTCRMI15.02, 23 December 2014).

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ (2015) Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473:2131–2138.  https://doi.org/10.1007/s11999-014-4078-8 CrossRefPubMedGoogle Scholar
  2. 2.
    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.  https://doi.org/10.5435/JAAOS-21-03-128 CrossRefPubMedGoogle Scholar
  3. 3.
    Fernandez-Fairen M, Murcia A, Blanco A, Merono A, Murcia A Jr, Ballester J (2010) Revision of failed total hip arthroplasty acetabular cups to porous tantalum components: a 5-year follow-up study. J Arthroplast 25:865–872.  https://doi.org/10.1016/j.arth.2009.07.027 CrossRefGoogle Scholar
  4. 4.
    Nehme A, Lewallen DG, Hanssen AD (2004) Modular porous metal augments for treatment of severe acetabular bone loss during revision hip arthroplasty. Clin Orthop Relat Res 429:201–208.  https://doi.org/10.1097/01.blo.0000150133.88271.80 CrossRefGoogle Scholar
  5. 5.
    Davies JH, Laflamme GY, Delisle J, Fernandes J (2011) Trabecular metal used for major bone loss in acetabular hip revision. J Arthroplast 26:1245–1250.  https://doi.org/10.1016/j.arth.2011.02.022 CrossRefGoogle Scholar
  6. 6.
    Konan S, Duncan CP, Masri BA, Garbuz DS (2016) Porous tantalum uncemented acetabular components in revision total hip arthroplasty: a minimum ten-year clinical, radiological and quality of life outcome study. Bone Joint J 98-B:767–771.  https://doi.org/10.1302/0301-620X.98B6.37183 CrossRefPubMedGoogle Scholar
  7. 7.
    Ilyas I, Alrumaih HA, Kashif S, Rabbani SA, Faqihi AH (2015) Revision of type III and type IVB acetabular defects with Burch-Schneider anti-Protrusio cages. J Arthroplast 30:259–264.  https://doi.org/10.1016/j.arth.2014.08.014 CrossRefGoogle Scholar
  8. 8.
    Regis D, Sandri A, Bonetti I (2014) Acetabular reconstruction with the Burch-Schneider antiprotrusio cage and bulk allografts: minimum 10-year follow-up results. Biomed Res Int 2014:194076.  https://doi.org/10.1155/2014/194076 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Noiseux NO, Long WJ, Mabry TM, Hanssen AD, Lewallen DG (2014) Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties. J Arthroplast 29:617–620.  https://doi.org/10.1016/j.arth.2013.07.037 CrossRefGoogle Scholar
  10. 10.
    Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS (2009) Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res 467:199–205.  https://doi.org/10.1007/s11999-008-0549-0 CrossRefPubMedGoogle Scholar
  11. 11.
    Gross AE, Goodman SB (2005) Rebuilding the skeleton: the intraoperative use of trabecular metal in revision total hip arthroplasty. J Arthroplast 20:91–93CrossRefGoogle Scholar
  12. 12.
    Petrera P, Rubash HE (1995) Revision total hip arthroplasty: the acetabular component. J Am Acad Orthop Surg 3:15–21CrossRefPubMedGoogle Scholar
  13. 13.
    Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Bohler N, Labek G (2013) Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplast 28:1329–1332.  https://doi.org/10.1016/j.arth.2013.01.012 CrossRefGoogle Scholar
  14. 14.
    Blumenfeld TJ, Meehan J (2014) The use of augment devices in revision acetabular surgery. JBJS reviews 2(3).  https://doi.org/10.2106/JBJS.RVW.M.00069
  15. 15.
    Azorín L (2005) Revisión acetabular en situaciones de defecto óseo masivo. Rev Esp Cir Ortop Traumatol 49:93–99CrossRefGoogle Scholar
  16. 16.
    D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137Google Scholar
  17. 17.
    George DA, Haddad FS (2014) Surgical management of periprosthetic joint infections: two-stage exchange. J Knee Surg 27:279–282.  https://doi.org/10.1055/s-0034-1376881 CrossRefPubMedGoogle Scholar
  18. 18.
    Singh JA, Schleck C, Harmsen S, Lewallen D (2016) Clinically important improvement thresholds for Harris Hip score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord 17:256.  https://doi.org/10.1186/s12891-016-1106-8 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bisseling P, Smolders JM, Hol A, van Susante JL (2011) No clear influence of preference bias on satisfaction and early functional outcome in resurfacing hip arthroplasty. Acta Orthop 82:161–165.  https://doi.org/10.3109/17453674.2011.566140 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32Google Scholar
  21. 21.
    Jones L, Grammatopoulos G, Singer G (2012) The Burch-Schneider cage: 9-year survival in Paprosky type 3 acetabular defects. Clin Radiol follow-up Hip Int: J Clin Exp Res Hip Pathol Ther 22:28–34.  https://doi.org/10.5301/hip.2012.9078 CrossRefGoogle Scholar
  22. 22.
    Makinen TJ, Kuzyk P, Safir OA, Backstein D, Gross AE (2016) Role of cages in revision arthroplasty of the acetabulum. J Bone Joint Surg Am 98:233–242.  https://doi.org/10.2106/JBJS.O.00143 CrossRefPubMedGoogle Scholar
  23. 23.
    Macheras G, Kateros K, Kostakos A, Koutsostathis S, Danomaras D, Papagelopoulos PJ (2009) Eight- to ten-year clinical and radiographic outcome of a porous tantalum monoblock acetabular component. J Arthroplast 24:705–709.  https://doi.org/10.1016/j.arth.2008.06.020 CrossRefGoogle Scholar
  24. 24.
    Gruen TA, Poggie RA, Lewallen DG, Hanssen AD, Lewis RJ, O’Keefe TJ, Stulberg SD, Sutherland CJ (2005) Radiographic evaluation of a monoblock acetabular component: a multicenter study with 2- to 5-year results. J Arthroplast 20:369–378CrossRefGoogle Scholar
  25. 25.
    Kim WY, Greidanus NV, Duncan CP, Masri BA, Garbuz DS (2008) Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results. Hip Int: J Clin Exp Res Hip Pathol Ther 18:17–22CrossRefGoogle Scholar
  26. 26.
    Unger AS, Lewis RJ, Gruen T (2005) Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips. J Arthroplast 20:1002–1009.  https://doi.org/10.1016/j.arth.2005.01.023 CrossRefGoogle Scholar
  27. 27.
    van Koeveringe AJ, Ochsner PE (2002) Revision cup arthroplasty using Burch-Schneider anti-protrusio cage. Int Orthop 26:291–295.  https://doi.org/10.1007/s00264-002-0361-5 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Brady OH, Masri BA, Garbuz DS, Duncan CP (1999) Use of reconstruction rings for the management of acetabular bone loss during revision hip surgery. J Am Acad Orthop Surg 7:1–7CrossRefPubMedGoogle Scholar
  29. 29.
    Batuyong ED, Brock HS, Thiruvengadam N, Maloney WJ, Goodman SB, Huddleston JI (2014) Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects. J Arthroplast 29:1318–1322.  https://doi.org/10.1016/j.arth.2013.12.002 CrossRefGoogle Scholar
  30. 30.
    Lamo-Espinosa J, Duart Clemente J, Diaz-Rada P, Pons-Villanueva J, Valenti-Nin JR (2013) The Burch-Schneider antiprotrusio cage: medium follow-up results. Musculoskelet Surg 97:31–37.  https://doi.org/10.1007/s12306-012-0233-0 CrossRefPubMedGoogle Scholar
  31. 31.
    Long WJ, Noiseux NO, Mabry TM, Hanssen AD, Lewallen DG (2015) Uncemented porous tantalum acetabular components: early follow-up and failures in 599 revision Total hip arthroplasties. Iowa Orthop J 35:108–113PubMedPubMedCentralGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Irene Isabel López-Torres
    • 1
  • Pablo Sanz-Ruíz
    • 1
    • 2
  • Coral Sánchez-Pérez
    • 1
  • Ricardo Andrade-Albarracín
    • 1
  • Javier Vaquero
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgeryHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Universidad Complutense de MadridMadridSpain

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