Advertisement

MUSCULOSKELETAL SURGERY

, Volume 93, Issue 1, pp 15–19 | Cite as

Total hip arthroplasty revision in elderly people with cement and Burch–Schneider anti-protrusio cage

  • L. Gaiani
  • R. Bertelli
  • Massimo PalmonariEmail author
  • G. Vicenzi
Original Article

Abstract

Total hip arthroplasty revision is increasingly becoming a common procedure, but the acetabular bone loss and the advanced age of the patients make revision procedures extremely complex and technically demanding. The aim of the present work is to examine the clinical and radiological results of the Burch–Schneider anti-protrusio cage (APC) implanted in revision hip arthroplasty with severe acetabular bone deficiency in elderly people. Between February 1994 and November 2005, a total of 60 revision operations of acetabular components were performed in 60 select patients (42 females and 18 males), using the Burch–Schneider APC. The indication for the Burch–Schneider APC use was massive pelvic bone loss with migration of the prosthesis cup and high-grade acetabular defects (type III or IV AAOS). The mean age at the time of surgery was 82 years (range 78–85 years). Polymethylmetacrylate cement (PMMA) was used to fill bony deficiencies in all the procedures. No graft was used. The average Harris Hip Score had improved from 28.2 preoperatively to 82.5 points at the time of follow-up. According to the classification of Gill et al., we have seen no Burch–Schneider cages definitely loose or probably. Only one acetabular component has been revised (for recurrent dislocation). Acetabular reconstruction with the use of cement and an acetabular support ring appears to have a useful role in the treatment of severe acetabular bony deficiency in elderly patients and may provide a definitive reconstruction.

Keywords

Burch–Schneider Bone defect Elderly people Revision arthroplasty 

Notes

Acknowledgments

We thank Lara Luchesa for her assistance in the preparation of this manuscript.

Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.

References

  1. 1.
    Treml J, Kroker PB (2000) Orthopaedic surgery in the elderly. Hosp Med 61:417–419PubMedGoogle Scholar
  2. 2.
    Brander VA, Malhotra S, Jet J, Heinemann AW, Stulberg SD (1997) Outcome of hip and knee arthroplasty in persons aged 80 years and older. Clin Orthop Relat Res 345:67–78PubMedCrossRefGoogle Scholar
  3. 3.
    Levy BA, Berry DJ, Pagnano MW (2000) Long-term survivorship of cemented all-polyethylene acetabular components in patients >75 years of age. J Arthroplasty 15(4):461–467PubMedCrossRefGoogle Scholar
  4. 4.
    Boettcher WG (1992) Total hip arthroplasties in the elderly morbidity, mortality and cost effectiveness. Clin Orthop Relat Res 274:30–34PubMedGoogle Scholar
  5. 5.
    Peterson VS, Simonsen S, Solgaard S (1989) Total hip replacement in patients aged 80 years older. J Am Geriatr Soc 37:219Google Scholar
  6. 6.
    Parvizi J, Pour AE, Keshavarzi NR, D’ Apuzzo M, Sharkey PF, Hozack WJ (2007) Revision total hip arthroplasty in octogenarians. A case-control study. J Bone Jt Surg Am 89(12):2612–2618Google Scholar
  7. 7.
    D’antonio JA, Capello WN, Borden LS (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Rel Res (243):126–137Google Scholar
  8. 8.
    Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. J Arthroplasty 9(1):33–44PubMedCrossRefGoogle Scholar
  9. 9.
    Paprosky WG, Bradford MS, Younger TI (1994) Classification of bone defects in failed prostheses. Chir Organi Mov 79:285–291PubMedGoogle Scholar
  10. 10.
    Eggli S, Brun S, Gerber C, Ganz R (2002) Comparison of polyethylene wear with femoral heads of 22 mm and 32 mm. J Bone Jt Surg Am 84(3):447–451CrossRefGoogle Scholar
  11. 11.
    Suh KT, Chang JW, Jung JS (2002) The role of inducible nitric oxide synthase in aseptic loosening after total hip arthroplasty. J Bone Jt Surg Am 84B(5):2612–2618Google Scholar
  12. 12.
    Young AM, Sychterz CJ, Hopper RH Jr, Engh CA (2002) Effect of acetabular modularity on polyethylene wear and osteolysis in total hip arthroplasty. J Bone Jt Surg Am 84A(1):58–63Google Scholar
  13. 13.
    Katz RP, Callaghan JJ, Sullivan PM, Johnston RC (1997) Long-term results of revision total hip arthroplasty with improved cementing technique. J Bone Jt Surg Br 79(2):322–326CrossRefGoogle Scholar
  14. 14.
    Nelson CL (2002) Cemented cup revisions Am J Orthop 31(8):479–480Google Scholar
  15. 15.
    Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R, Callaghan JJ (1985) Long-term results of revision total hip replacement. A follow-up report. J Bone Jt Surg Am 67(4):513–516Google Scholar
  16. 16.
    Kavanagh BF, Ilstrup DM, Fitzgerald RH Jr (1985) Revision total hip arthroplasty. J Bone Jt Surg Am 67(4):517–526Google Scholar
  17. 17.
    Amstutz HC, Ma SM, Jinnah RH, Mai L (1982) Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res 170:21–33PubMedGoogle Scholar
  18. 18.
    Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Jt Surg Am 67(7):1074–1085Google Scholar
  19. 19.
    Brubaker SM, Brown TE, Manaswi A, Mihalko WM, Cui Q, Saleh KJ (2007) Treatment options and allograft use in revision total hip arthroplasty the acetabulum. J Arthroplasty 22:52–56PubMedCrossRefGoogle Scholar
  20. 20.
    Samuelson KM, Freeman MAR, Levack B, Rasmussen GL, Revell PA (1988) Homograft bone in revision acetabular arthroplasty, a clinical and radiographic study. J Bone Jt Surg Am 70B:367–372Google Scholar
  21. 21.
    Weeden SH, Schmidt RH. The use of tantalum porous metal implants for Paprosky 3A and 3B defects (2007) J Arthroplasty 22(6 Suppl 2):151–155Google Scholar
  22. 22.
    Schreurs BW, Busch VJ, Welten ML, Verdonschot N, Slooff TJ, Gardeniers JW (2004) Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old. J Bone Jt Surg Am 86A(11):2385–2392Google Scholar
  23. 23.
    Boscainos PJ, Kellett CF, Maury AC, Backstein D, Gross AE (2007) Management of periacetabular bone loss in revision hip arthroplasty. Clin Orthop Relat Res 465:159–165PubMedGoogle Scholar
  24. 24.
    Trancik TM, Stulberg TBN, Wilde AH, Feiglin DH (1986) Allograft reconstruction of the acetabulum during revision total hip arthroplasty. J Bone Jt Surg Am 68(4):527–533Google Scholar
  25. 25.
    Wilson MG, Nikpoor N, Aliabadi P, Poss R, Weissman BN (1989) The fate of acetabular allografts after bipolar revision arthroplasty of the hip. J Bone Jt Surg Am 71(10):1469–1479Google Scholar
  26. 26.
    Hedde C, Postel M, Kerboul M, Courpied JP (1986) La reparation du cotyle par homogreffe osseuse conservée au cours des révisions de prothése totale de hanche. Rev Chir Orthop 72:267–276Google Scholar
  27. 27.
    Paprosky WG, Perona PG, Magnus RG (1993) revision of the severely deficient acetabulum.-When is cement necessary? 60th annual meeting, AAOS, San Francisco, CA Google Scholar
  28. 28.
    Berry DJ, Muller ME (1992) Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Jt Surg Am 74(5):711–715Google Scholar
  29. 29.
    Sutherland CJ (1996) Treatment of type III acetabular deficiencies in revision total hip arthroplasty without structural bone-graft. J Arthroplasty 11(1):91–98PubMedCrossRefGoogle Scholar
  30. 30.
    Winter E, Piert M, Wolkman R, Maurer F, Eingartner C, Weise K, Weller S (2001) Allogenic cancellous bone graft and Burch–Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Jt Surg Am 83A(6):862–867Google Scholar
  31. 31.
    Bonnomet F, Clavert P, Lefèbvre Y, Kempf JF (2001) Reconstruction by graft and metallic reinforcement device in severe aseptic acetabular loosening: 10 years survivorship analysis. Rev Chir Orthop 87:135–146PubMedGoogle Scholar
  32. 32.
    Engh CA, Glassman AH, Griffin WL, Mayer JG (1998) Results of cementless revision for failed cemented total hip arthroplasty. Clin Orthop Relat Res 235:91–110Google Scholar
  33. 33.
    Hoikka V, Schlenzka D, Wirta J, Paavilainen T, Eskola A, Santavirta S, Lindholm TS (1993) Failures after revision hip arthroplasties with threaded cups and structural bone allografts: loosening of 13/18 cases after 1–4 years. Acta Orthop 64(4):403–407CrossRefGoogle Scholar
  34. 34.
    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 Jt Surg Am 51:737–755Google Scholar
  35. 35.
    Gill TJ, Sledge JB, Muller ME (1998) The Burch–Schneider anti-protrusio cage in revision total hip arthroplasty. J Bone Jt Surg Am 80B(6):234–238Google Scholar
  36. 36.
    Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Jt Surg Am 55(8):1629–1632Google Scholar
  37. 37.
    Rosson J, Schatzker J (1992) The use of reinforcement rings to reconstruct deficient acetabula. J Bone Jt Surg Br 74(5):716–720Google Scholar
  38. 38.
    Iwaki H, Scott G, Freeman MAR (2002) The natural history and significance of radiolucent lines at a cemented femoral interface. J Bone Jt Surg Am 84(4):550–555CrossRefGoogle Scholar
  39. 39.
    McFarland EG, Lewallen DG, Cabanela ME (1991) Use of bipolar endoprosthesis and bone grafting for acetabular reconstruction. Clin Orthop Relat Res 268:128–139PubMedGoogle Scholar
  40. 40.
    Papagelopoulos PJ, Lewallen DG, Cabanela ME, McFarland EG, Wallrichs SL (1995) Acetabular reconstruction using bipolar endoprosthesis and bone grafting in patients with severe bone deficiency. Clin Orthop Relat Res 314:170–184PubMedGoogle Scholar
  41. 41.
    Wilson MG, Scott RD (1993) Bipolar socket in protrusio acetabuli 3–6 year study. J Arthroplasty 8(4):405–411PubMedCrossRefGoogle Scholar
  42. 42.
    Lachiewicz PF, Hussamy OD (1994) Revision of the acetabulum without cement with use of the Harris–Galante porous-coated implant. Two to eight-year results. J Bone Jt Surg Am 76(12):1834–1839Google Scholar
  43. 43.
    Dorr LD, Wan Z (1995) Ten years of experience with porous acetabular components for revision surgery. Clin Orthop Relat Res 319:191–200PubMedGoogle Scholar
  44. 44.
    Köster G, Willert HG, Köhler HP, Döpkens K (1998) An oblong revision cup for large acetabular defects: design rationale and two- to seven-year follow-up. J Arthroplasty 13(5):559–569PubMedCrossRefGoogle Scholar
  45. 45.
    Sutherland CJ (1996) Early experience with eccentric acetabular components in revision total hip arthroplasty. Am J Orthop 25(4):284–289PubMedGoogle Scholar
  46. 46.
    Abeyta PN, Namba RS, Janku GV, Murray WR, Kim HT (2008) Reconstruction of major segmental acetabular defects with an oblong-shaped cementless prosthesis: a long-term outcomes study. J Arthroplasty 23(2):247–253PubMedCrossRefGoogle Scholar
  47. 47.
    Perka C, Ludwig R (2001) Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch–Schneider anti-protrusio cage. J Arthroplasty 16(5):568–574PubMedCrossRefGoogle Scholar
  48. 48.
    Symeonides P, Petsatodes G, Pournaras J, Kapetanos G, Christodoulo A, Papadopulos P (1997) Replacement of deficient acetabulum using Burch–Schneider cages. Acta Orthop Scand 68(Suppl 275):30–32Google Scholar
  49. 49.
    Winter E, Piert M, Volkmann R, Maurer F, Eingartner C, Weise K, Weller S (2001) Allogeneic cancellous bone graft and a Burch–Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Jt Surg Am 83A(6):862–867Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • L. Gaiani
    • 1
  • R. Bertelli
    • 1
  • Massimo Palmonari
    • 1
    • 2
    Email author
  • G. Vicenzi
    • 1
  1. 1.Department of Orthopaedics SurgeryS. Maria della Scaletta HospitalImola (Bo)Italy
  2. 2.Divisione Ortopedia e TraumatologiaOspedale Civile Nuovo Santa Maria della ScalettaImola (Bo)Italy

Personalised recommendations