Skip to main content

Advertisement

SpringerLink
Log in

Abstützschalen in der Revisionsendoprothetik der Hüfte

Mittelfristige Ergebnisse von 298 Implantaten

Acetabular reinforcement rings in revision total hip arthroplasty

Midterm results in 298 cases

  • Originalien
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Revision einer gelockerten und migrierten Pfannenkomponente mit Knochenverlust im Rahmen der Hüftendoprothetik stellt eine große chirurgische Herausforderung dar. Ziel sollte eine funktionell günstige Rekonstruktion des Rotationszentrums bei suffizienter, mechanischer Belastbarkeit des Acetabulums sein. Die diesbezüglich in Europa am häufigsten eingesetzten Revisionsimplantate sind die Müller-Abstützschale, die Hakendachschale nach Ganz, sowie der Burch-Schneider-Ring.

Patienten und Methoden

Wir berichten über unsere Erfahrungen mit diesen Implantaten bei 298 Patienten (298 Hüften) und einer medianen Nachuntersuchungszeit von 4 (0–17) Jahren im Rahmen einer retrospektiven Studie.

Ergebnisse

Von 224 Patienten (75%) konnten Nachuntersuchungsdaten erhoben werden. Hierbei wurde bei 176 Patienten (59%) eine radiologische Untersuchung durchgeführt. Weiterhin waren 54 Patienten (18%) verstorben, von 3 Patienten (1%) konnten keine Daten erhoben werden. Bei 18 Patienten (6%) wurde im Nachbeobachtungszeitraum eine erneute Revision durchgeführt, davon war in 9 Fällen die Ursache eine aseptische Lockerung, bei den übrigen 9 Fällen eine septische Lockerung. In 7 weiteren Fällen (2%) wurde im Rahmen der Nachuntersuchung ein radiologisches und klinisches Versagen des Implantats diagnostiziert. Die Überlebensrate nach 5 Jahren betrug 94% bzw. 89% nach 8 Jahren.

Schlussfolgerung

Die Revision mit Abstützschalen führt zu akzeptablen, mittelfristigen Ergebnissen. Hauptsorgenpunkte bilden die septischen Komplikationen sowie das lytische Versagen des Spongiosatransplantats mit konsekutiver Lockerung des Abstützrings.

Abstract

Background

Acetabular revision in total hip arthroplasty (THA), especially for loose or migrated cup components with collateral bone loss, remains a great surgical challenge. The aim should always be a functionally favorable reconstruction of the rotation center with sufficient load capacity of the acetabulum. Commonly used implants in Europe are the Mueller ring, the Ganz ring, and the Burch–Schneider cage.

Patients and Methods

We report our results of 298 patients (298 hips) with a median follow-up period of 4 (range 0–17) years in a retrospective series.

Results

Follow-up data were available in 224 cases (75%). A radiographic examination was performed in 176 (59%) patients. Another 54 patients (18%) had died in the follow-up period, while another three patients (1%) were lost to follow-up. Eighteen patients (16%) underwent re-revision, in nine cases for aseptic loosening and in the remaining nine cases for infection. In seven additional cases (2%), radiological and clinical failure was found during follow-up. The overall survival rate was 94% at 5 years and 89% at 8 years.

Conclusion

Revision THA using acetabular reinforcement rings results in acceptable midterm results. However, septic complications and lysis of the bone graft with consecutive failure of the reinforcement ring remain problematic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Amstutz HC, Ma SM, Jinnah RH, Mai L (1982) Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res 170: 21–33

    PubMed  Google Scholar 

  2. Berry DJ, Muller ME (1992) Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br 74: 711–715

    PubMed  CAS  Google Scholar 

  3. Bohm P, Banzhaf S (1999) Acetabular revision with allograft bone. 103 revisions with 3 reconstruction alternatives, followed for 0.3–13 years. Acta Orthop Scand 70: 240–249

    PubMed  CAS  Google Scholar 

  4. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55: 1629–1632

    PubMed  CAS  Google Scholar 

  5. Cabanela ME (1998) Reconstruction rings and bone graft in total hip revision surgery. Orthop Clin North Am 29: 255–262

    Article  PubMed  CAS  Google Scholar 

  6. Campbell DG, Garbuz DS, Masri BA, Duncan CP (2001) Reliability of acetabular bone defect classification systems in revision total hip arthroplasty. J Arthroplasty 16: 83–86

    Article  PubMed  CAS  Google Scholar 

  7. Carroll FA, Hoad-Reddick DA, Kerry RM, Stockley I (2008) The survival of support rings in complex acetabular revision surgery. J Bone Joint Surg Br 90: 574–578

    Article  PubMed  CAS  Google Scholar 

  8. Charnley J (1972) The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 54: 61–76

    PubMed  CAS  Google Scholar 

  9. D’Antonio JA, Capello WN, Borden LS et al. (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop 243: 126–137

    Google Scholar 

  10. D’Aubigné M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36: 451–475

    Google Scholar 

  11. DeBoer DK, Christie MJ, Brinson MF, Morrison JC (2007) Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 89: 835–840

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  13. Dorey FJ, Korn EL (1987) Effective sample sizes for confidence intervals for survival probabilities. Stat Med 6: 679–687

    Article  PubMed  CAS  Google Scholar 

  14. Gerber A, Pisan M, Zurakowski D, Isler B (2003) Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty. J Bone Joint Surg Am 85: 2358–2364

    PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  16. Goodman S, Saastamoinen H, Shasha N, Gross A (2004) Complications of ilioischial reconstruction rings in revision total hip arthroplasty. J Arthroplasty 19: 436–446

    Article  PubMed  Google Scholar 

  17. Gotze C, Sippel C, Wendt G, Steinbeck J (2003) Limits in cementless hip revision total hip arthroplasty. Midterm experience with an oblong revision cup. Z Orthop Ihre Grenzgeb 141: 182–189

    Article  PubMed  CAS  Google Scholar 

  18. Gross AE, Wong P, Saleh KJ (2002) Don’t throw away the ring indications and use. J Arthroplasty 17: 162–166

    Article  PubMed  Google Scholar 

  19. Gurtner P, Aebi M, Ganz R (1993) The acetabular roof cup in revision arthroplasty of the hip. Z Orthop Ihre Grenzgeb 131: 594–600

    Article  PubMed  CAS  Google Scholar 

  20. Haddad FS, Shergill N, Muirhead-Allwood SK (1999) Acetabular reconstruction with morcellized allograft and ring support a medium-term review. J Arthroplasty 14: 788–795

    Article  PubMed  CAS  Google Scholar 

  21. Harris WH (1993) Bulk versus morselized bone graft in acetabular revision total hip replacement. Semin Arthroplasty 4: 68–71

    PubMed  CAS  Google Scholar 

  22. 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

    PubMed  CAS  Google Scholar 

  23. Hedley AK, Gruen TA, Ruoff DP (1988) Revision of failed total hip arthroplasties with uncemented porous-coated anatomic components. Clin Orthop Relat Res: 75–90

    Google Scholar 

  24. Hoikka V, Schlenzka D, Wirta J et al. (1993) Failures after revision hip arthroplasties with threaded cups and structural bone allografts. Loosening of 13/18 cases after 1-4 years. Acta Orthop Scand 64: 403–407

    PubMed  CAS  Google Scholar 

  25. Hooten JP jr, Engh CA jr, Engh CA (1994) Failure of structural acetabular allografts in cementless revision hip arthroplasty. J Bone Joint Surg Br 76: 419–422

    PubMed  Google Scholar 

  26. Ilchmann T, Gelzer JP, Winter E, Weise K (2006) Acetabular reconstruction with the Burch-Schneider ring an EBRA analysis of 40 cup revisions. Acta Orthop 77: 79–86

    Article  PubMed  Google Scholar 

  27. Kafer W, Fraitzl CR, Kinkel S et al. (2004) Analysis of validity and reliability of three radiographic classification systems for preoperative assessment of bone stock loss in revision total hip arthroplasty. Z Orthop Ihre Grenzgeb 142: 33–39

    Article  PubMed  CAS  Google Scholar 

  28. Koster G, Rading S (2008) Revision of failed acetabular components utilizing a cementless oblong cup: an average 9-year follow-up study. Arch Orthop Trauma Surg (in press)

  29. Kwong LM, Jasty M, Harris WH (1993) High failure rate of bulk femoral head allografts in total hip acetabular reconstructions at 10 years. J Arthroplasty 8: 341–346

    Article  PubMed  CAS  Google Scholar 

  30. McGann WA, Welch RB, Picetti GD, 3rd (1988) Acetabular preparation in cementless revision total hip arthroplasty. Clin Orthop Relat Res 235: 35–46

    PubMed  Google Scholar 

  31. Mulroy RD jr, Harris WH (1990) Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence: a follow-up note. J Bone Joint Surg Am 72: 1536–1540

    PubMed  Google Scholar 

  32. Murray DW, Britton AR, Bulstrode CJ (1997) Loss to follow-up matters. J Bone Joint Surg Br 79: 254–257

    Article  PubMed  CAS  Google Scholar 

  33. Paprosky WG, Sporer SS, Murphy BP (2007) Addressing severe bone deficiency what a cage will not do. J Arthroplasty 22: 111–115

    Article  PubMed  Google Scholar 

  34. Pascarel X, Liquois F, Chauveaux D et al. (1993) The use of Muller acetabular rings in revision surgery of total hip prosthesis. Apropos of 141 cases with a minimal 5-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 79: 357–364

    PubMed  CAS  Google Scholar 

  35. Pereira GC, Kubiak EN, Levine B et al. (2007) Cavitary acetabular defects treated with morselized cancellous bone graft and cementless cups. Int Orthop 31: 445–450

    Article  PubMed  CAS  Google Scholar 

  36. 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: 568–574

    Article  PubMed  CAS  Google Scholar 

  37. Piriou P, Norton M, Marmorat JL, Judet T (2005) Acetabular reconstruction in revision hip surgery using femoral head block allograft. Orthopedics 28: 1437–1444

    PubMed  Google Scholar 

  38. Rosson J, Schatzker J (1992) The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br 74: 716–720

    PubMed  CAS  Google Scholar 

  39. Schatzker J, Wong MK (1999) Acetabular revision. The role of rings and cages. Clin Orthop Relat Res 369: 187–197

    Article  PubMed  Google Scholar 

  40. Schlegel UJ, Bitsch RG, Pritsch M et al. (2006) Mueller reinforcement rings in acetabular revision outcome in 164 hips followed for 2–17 years. Acta Orthop 77: 234–241

    Article  PubMed  Google Scholar 

  41. Schreurs BW, van Tienen TG, Buma P et al. (2001) Favorable results of acetabular reconstruction with impacted morsellized bone grafts in patients younger than 50 years a 10- to 18-year follow-up study of 34 cemented total hip arthroplasties. Acta Orthop Scand 72: 120–126

    Article  PubMed  CAS  Google Scholar 

  42. Shih CH, Chen CH, Tsai MF, Tzen KY (1994) Incorporation of allograft for acetabular reconstruction. Single photon emission CT in 21 hip arthroplasties followed for 2.5–5 years. Acta Orthop Scand 65: 589–594

    Article  PubMed  CAS  Google Scholar 

  43. Shinar AA, Harris WH (1997) Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty. Sixteen-year-average follow-up. J Bone Joint Surg Am 79: 159–168

    PubMed  CAS  Google Scholar 

  44. Siebenrock KA, Trochsler M, Sadri H, Ganz R (2001) Hooked roof cup in revision of difficult loose hip prosthesis cups. Results after a minimum of 10 years. Orthopade 30: 273–279

    Article  PubMed  CAS  Google Scholar 

  45. Slooff TJ, Buma P, Schreurs BW et al. (1996) Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop Relat Res 324: 108–115

    Article  PubMed  Google Scholar 

  46. Sporer SM, Paprosky WG (2006) Acetabular revision using a trabecular metal acetabular component for severe acetabular bone loss associated with a pelvic discontinuity. J Arthroplasty 21: 87–90

    Article  PubMed  Google Scholar 

  47. Starker M, Kandziora F, Jager A, Kerschbaumer F (1998) Acetabular reconstruction using acetabular reinforcement rings. Orthopade 27: 366–374

    Article  PubMed  CAS  Google Scholar 

  48. Stiehl JB, Saluja R, Diener T (2000) Reconstruction of major column defects and pelvic discontinuity in revision total hip arthroplasty. J Arthroplasty 15: 849–857

    Article  PubMed  CAS  Google Scholar 

  49. Udomkiat P, Dorr LD, Won YY et al. (2001) Technical factors for success with metal ring acetabular reconstruction. J Arthroplasty 16: 961–969

    Article  PubMed  CAS  Google Scholar 

  50. 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 Arthroplasty 20: 1002–1009

    Article  PubMed  Google Scholar 

  51. van der Donk S, Buma P, Slooff TJ et al. (2002) Incorporation of morselized bone grafts: a study of 24 acetabular biopsy specimens. Clin Orthop 396: 131–141

    Article  Google Scholar 

  52. van der Linde M, Tonino A (2001) Acetabular revision with impacted grafting and a reinforcement ring: 42 patients followed for a mean of 10 years. Acta Orthop Scand 72: 221–227

    Article  Google Scholar 

  53. Wedemeyer C, Neuerburg C, Heep H et al. (2008) Jumbo cups for revision of acetabular defects after total hip arthroplasty: a retrospective review of a case series. Arch Orthop Trauma Surg 128: 545–550

    Article  PubMed  Google Scholar 

  54. Winter E, Piert M, Volkmann R.et al. (2001) Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 83: 862–867

    PubMed  Google Scholar 

  55. Zehntner MK, Ganz R (1994) Midterm results (5.5–10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision. J Arthroplasty 9: 469–479

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50924, Köln, Deutschland

    U.J. Schlegel

  2. Orthopädische Universitätsklinik, Heidelberg, Deutschland

    R.G. Bitsch & P.R. Aldinger

  3. Institut für Medizinische Biometrie und Informatik, Universität, Heidelberg, Deutschland

    M. Pritsch

  4. Endo-Klinik, Hamburg, Deutschland

    H. Mau

  5. Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, Schottland, Großbritannien

    S.J. Breusch

Authors
  1. U.J. Schlegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R.G. Bitsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Pritsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P.R. Aldinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Mau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S.J. Breusch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U.J. Schlegel.

Additional information

Dr. U.J. Schlegel ist Wissenschaftlicher Mitarbeiter an der Klinik und Poliklinik für Orthopädie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schlegel, U., Bitsch, R., Pritsch, M. et al. Abstützschalen in der Revisionsendoprothetik der Hüfte. Orthopäde 37, 904–913 (2008). https://doi.org/10.1007/s00132-008-1314-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-008-1314-5

Schüsselwörter

Keywords

Search

Navigation