Skip to main content

Advertisement

SpringerLink
Log in

Individuell angepasster Beckenteilersatz in der Hüftgelenksrevision

Custom-made acetabular implants in revision total hip arthroplasty

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

Zusammenfassung

Hintergrund

Höhergradige azetabuläre Defekte stellen den Operateur in der Revisionsendoprothetik zunehmend vor Herausforderungen.

Ziel

In der vorliegenden Übersichtsarbeit soll die Versorgungsoption des individuellen Beckenteilersatzes bei ausgedehnten Knochenverlusten im Bereich des Azetabulums vorgestellt und die Vor- und Nachteile diskutiert werden.

Material und Methoden

In einer selektiven Literaturrecherche wurden die Ergebnisse der individuell angefertigten Beckenteilersätze mit ihren Vor- und Nachteilteilen zusammengestellt und diskutiert.

Ergebnisse

In den letzten Jahren haben die Publikationen über individuelle Beckenteilersätze bei ausgeprägten azetabulären Defekten deutlich zugenommen. Die in der Literatur durchschnittlich angegebene Überlebensrate liegt bei >90 %, bei einem Nachuntersuchungszeit von mindestens 2 Jahren.

Die Literatur zeigt, dass der individuelle Beckenteilersatz eine stabile und zuverlässige Versorgung von Patienten mit Knochendefekten Grad III a/b nach Paprosky oder III–V der AAOS erlaubt. Die individuelle Konstruktion der Implantate ermöglicht die Rekonstruktion des Rotationszentrums. Allerdings sind Planung und Vorbereitung dieser Eingriffe mit einem hohen Zeitaufwand verbunden und die Kosten für die Anfertigung eines individuellen Implantates sind nicht unerheblich.

Schlussfolgerung

Der individuelle Beckenteilersatz wird zunehmend für die Versorgung von höhergradigen azetabulären Defekten eingesetzt und stellt nach dem aktuellen Stand der Literatur eine zuverlässige Versorgungsoption dar.

Abstract

Background

Management of acetabular bone loss is a demanding problem in revision total hip arthroplasty.

Objectives

The aim of this review is to introduce and discuss the results and the advantages and disadvantages of custom-made implants as a treatment option for severe acetabular bone defects.

Materials and methods

A selective review of the existing literature of custom made acetabular implants was performed on PubMed.

Results

Studies showed good clinical and radiological outcomes of custom made acetabular implants and a survival rate of more than 90%.

Conclusion

Custom-made acetabular implants are a reliable treatment option for severe acetabular defects and allow the reconstruction of the centre of rotation of the hip. The costs of these implants are high and planning is time consuming.

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

Abbreviations

AAOS:

American Academy of Orthopaedic Surgeons

Literatur

  1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519

    Article  Google Scholar 

  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785

    Article  Google Scholar 

  3. Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6‑year follow-up evaluation. J Arthroplasty 9:33–44

    Article  CAS  Google Scholar 

  4. 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. https://doi.org/10.1097/00003086-198906000-00019

  5. 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

    Article  CAS  Google Scholar 

  6. Gunther KP, Wegner T, Kirschner S, Hartmann A (2014) Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments: the cage-and-augment system. Oper Orthop Traumatol 26:141–155

    Article  Google Scholar 

  7. Scheele C, Harrasser N, Suren C, Pohling F, von Eisenhart-Rothe R, Prodinger PM (2018) Prospects and challenges of indiviualized implants in the treatment of large acetabular defects. OUP Orthop Unfallchir Prax 7:204–211

    Google Scholar 

  8. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK (2001) Bridging massive acetabular defects with the triflange cup: 2‑ to 9‑year results. Clin Orthop Relat Res 393:216–227

    Article  Google Scholar 

  9. Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G (2020) Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 140:415–424

    Article  Google Scholar 

  10. Berend ME, Berend KR, Lombardi AV, Cates H, Faris P (2018) The patient-specific Triflange acetabular implant for revision total hip arthroplasty in patients with severe acetabular defects: planning, implantation, and results. Bone Joint J 100-B:50–54

    Article  CAS  Google Scholar 

  11. Citak M, Kochsiek L, Gehrke T, Haasper C, Suero EM, Mau H (2018) Preliminary results of a 3D-printed acetabular component in the management of extensive defects. Hip Int 28:266–271

    Article  Google Scholar 

  12. Gladnick BP, Fehring KA, Odum SM, Christie MJ, DeBoer DK, Fehring TK (2018) Midterm survivorship after revision total hip arthroplasty with a custom triflange acetabular component. J Arthroplasty 33:500–504

    Article  Google Scholar 

  13. Kieser DC, Ailabouni R, Kieser SCJ, Wyatt MC, Armour PC, Coates MH, Hooper GJ (2018) The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2‑year follow-up. Hip Int 28:668–674

    Article  Google Scholar 

  14. Moore KD, McClenny MD, Wills BW (2018) Custom triflange acetabular components for large acetabular defects: minimum 10-year follow-up. Orthopedics 41:e316–e320

    Article  Google Scholar 

  15. De Martino I, Strigelli V, Cacciola G, Gu A, Bostrom MP, Sculco PK (2019) Survivorship and clinical outcomes of custom triflange acetabular components in revision total hip Arthroplasty: a systematic review. J Arthroplasty 34:2511–2518

    Article  Google Scholar 

  16. Jones CW, Choi DS, Sun P, Chiu YF, Lipman JD, Lyman S, Bostrom MPG, Sculco PK (2019) Clinical and design factors influence the survivorship of custom flange acetabular components. Bone Joint J 101-B:68–76

    Article  CAS  Google Scholar 

  17. Weber M, Witzmann L, Wieding J, Grifka J, Renkawitz T, Craiovan B (2019) Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty. Int Orthop 43:2235–2243

    Article  Google Scholar 

  18. Froschen FS, Randau TM, Hischebeth GTR, Gravius N, Gravius S, Walter SG (2020) Mid-term results after revision total hip arthroplasty with custom-made acetabular implants in patients with Paprosky III acetabular bone loss. Arch Orthop Trauma Surg 140:263–273

    Article  CAS  Google Scholar 

  19. Walter SG, Randau TM, Gravius N, Gravius S, Froschen FS (2020) Monoflanged custom-made acetabular components promote biomechanical restoration of severe acetabular bone defects by metallic defect reconstruction. J Arthroplasty 35:831–835

    Article  Google Scholar 

  20. Joshi AB, Lee J, Christensen C (2002) Results for a custom acetabular component for acetabular deficiency. J Arthroplasty 17:643–648

    Article  Google Scholar 

  21. Holt GE, Dennis DA (2004) Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 429:209–214

    Article  Google Scholar 

  22. Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ (2012) Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res 470:428–434

    Article  Google Scholar 

  23. 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  Google Scholar 

  24. Colen S, Harake R, De Haan J, Mulier M (2013) A modified custom-made triflanged acetabular reconstruction ring (MCTARR) for revision hip arthroplasty with severe acetabular defects. Acta Orthop Belg 79:71–75

    PubMed  Google Scholar 

  25. Wind MA Jr., Swank ML, Sorger JI (2013) Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 36:e260–e265

    Article  Google Scholar 

  26. Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38:2455–2461

    Article  Google Scholar 

  27. Berasi CC, Berend KR, Adams JB, Ruh EL, Lombardi AV Jr. (2015) Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res 473:528–535

    Article  Google Scholar 

  28. Barlow BT, Oi KK, Lee YY, Carli AV, Choi DS, Bostrom MP (2016) Outcomes of custom flange acetabular components in revision total hip arthroplasty and predictors of failure. J Arthroplasty 31:1057–1064

    Article  Google Scholar 

  29. Li H, Qu X, Mao Y, Dai K, Zhu Z (2016) Custom acetabular cages offer stable fixation and improved hip scores for revision THA with severe bone defects. Clin Orthop Relat Res 474:731–740

    Article  Google Scholar 

  30. Mao Y, Xu C, Xu J, Li H, Liu F, Yu D, Zhu Z (2015) The use of customized cages in revision total hip arthroplasty for Paprosky type III acetabular bone defects. Int Orthop 39:2023–2030

    Article  Google Scholar 

  31. Baauw M, van Hellemondt GG, Spruit M (2017) A custom-made acetabular implant for Paprosky type 3 defects. Orthopedics 40:e195–e198

    Article  Google Scholar 

  32. Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS (2019) Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg 103:1–13

    Article  CAS  Google Scholar 

  33. Matar HE, Selvaratnam V, Shah N, Wynn Jones H (2020) Custom triflange revision acetabular components for significant bone defects and pelvic discontinuity: early UK experience. J Orthop 21:25–30

    Article  Google Scholar 

  34. Myncke I, van Schaik D, Scheerlinck T (2017) Custom-made triflanged acetabular components in the treatment of major acetabular defects. Short-term results and clinical experience. Acta Orthop Belg 83:341–350

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland

    Gabriela von Lewinski

Authors
  1. Gabriela von Lewinski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriela von Lewinski.

Ethics declarations

Interessenkonflikt

G. von Lewinski gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Lewinski, G. Individuell angepasster Beckenteilersatz in der Hüftgelenksrevision. Orthopäde 49, 417–423 (2020). https://doi.org/10.1007/s00132-020-03909-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-020-03909-5

Schlüsselwörter

Keywords

Search

Navigation