Reconstruction of AAOS type III and IV acetabular defects with the Ganz reinforcement ring: high failure in pelvic discontinuity
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Large acetabular defects and pelvic discontinuity represent complex problems in revision total hip arthroplasty. This study aimed to investigate whether reconstruction with the Ganz reinforcement ring would provide durable function in large acetabular defects.
Patients and methods
46 hips (45 patients, 19 male, 26 female, mean age 68 years) with AAOS type III and IV defects undergoing acetabular revision with the Ganz reinforcement ring were evaluated at a mean follow-up of 74 months (24–161 months). Fourteen patients died during follow-up. All surviving patients were available for clinical assessment and radiographic studies. Radiographs were evaluated for bone healing and component loosening. A Cox-regression model was performed to identify factors influencing survival of the Ganz-ring.
In the group of AAOS III defects, 3 of 26 acetabular reconstructions failed, all due to aseptic loosening. In pelvic discontinuity (AAOS IV), 9 of 20 hips failed due to aseptic loosening (n = 4), deep infection (n = 3), and non-union of the pelvic ring (n = 2). With acetabular revision for any reason as an endpoint, the estimated Kaplan–Meier 5-year survival was 86% in type III defects and 57% in type IV defects, respectively. The presence of pelvic discontinuity was identified as the only independent predictive factor for failure of the Ganz ring acetabular reconstruction (AAOS III vs. IV, Hazard ratio: 0.217, 95%, Confidence interval: 0.054–0.880, p = 0.032).
The Ganz reinforcement ring remains a favorable implant for combined segmental and cavitary defects. However, defects with pelvic discontinuity demonstrate high failure rates. The indications should therefore be narrowed to acetabular defects not associated with pelvic discontinuity.
KeywordsGanz reinforcement ring Pelvic discontinuity Acetabular defect Bone loss Trabecular metal Cage Acetabular reconstruction Hip revision
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
There is no funding source.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 2.Abolghasemian M, Sadeghi Naini M, Tangsataporn S, Lee P, Backstein D, Safir O et al (2014) Reconstruction of massive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Jt J 96-B(3):319–324CrossRefGoogle Scholar
- 10.D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG et al (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137Google Scholar
- 11.DeBoer DK, Christie MJ, Brinson MF, Morrison JC (2007) Revision total hip arthroplasty for pelvic discontinuity. J Bone Jt Surg Am 89(4):835–840Google Scholar
- 18.Issack PS, Nousiainen M, Beksac B, Helfet DL, Sculco TP, Buly RL (2009) Acetabular component revision in total hip arthroplasty. Part II: management of major bone loss and pelvic discontinuity. Am J Orthop (Belle Mead NJ) 38(11):550–556Google Scholar
- 23.Philippe R, Gosselin O, Sedaghatian J, Dezaly C, Roche O, Sirveaux F et al (2012) Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res 98(2):129–137CrossRefGoogle Scholar
- 24.Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P (2012) A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplasty 27(6):1057–1063e1Google Scholar
- 26.Schlegel UJ, Bitsch RG, Pritsch M, Aldinger PR, Mau H, Breusch SJ (2008) Acetabular reinforcement rings in revision total hip arthroplasty: midterm results in 298 cases. Orthopade 37(9):904, 906–913Google Scholar