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Beyond type III Paprosky acetabular defects: are partial pelvic replacements with iliosacral fixation successful?

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Abstract

Purpose

Supra-acetabular bone loss close beyond the sciatic notch is one of the most challenging defect types for stable anatomical reconstruction in revision arthroplasty. Using reconstruction strategies from tumour orthopaedic surgery, we adapted tricortical trans-iliosacral fixation options for custom-made implants in revision arthroplasty. The aim of the present study was to present the clinical and radiological results of this extraordinary pelvic defect reconstruction.

Methods

Between 2016 and 2021, 10 patients with a custom-made pelvic construct using tricortical iliosacral fixation (see Fig. 1) were included in the study. Follow-up was 34 (SD 10; range 15–49) months. Postoperatively CT scans evaluating the implant position were performed. Functional outcome and the clinical results were recorded.

Results

Implantation was possible as planned in all cases in 236 (SD 64: range 170–378) min. Correct centre of rotation (COR) reconstruction was possible in nine cases. One sacrum screw crossed a neuroforamen in one case without clinical symptoms. During the follow-up period, four further operations were required in two patients. There were no individual implant revisions or aseptic loosening recorded. The Harris Hip Score increased significantly from 27 Pts. to 67 Pts. with a mean improvement of 37 (p < 0.005). EQ-5D developed from 0.562 to 0.725 (p = 0.038) as a clear improvement in quality of life.

Conclusion

Custom-made partial pelvis replacement with iliosacral fixation offers a safe solution in “beyond Paprosky type III defects” for hip revision arthroplasty. Due to meticulous planning, precise implantation with good clinical outcome can be achieved. Furthermore, the functional outcome and patient satisfaction increased significantly showing promising early results with a relatively low complication rate.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank Peter Scheinemann for the digital implant analysis and Nicole Bouchkhachakh for her assistance in the preparation of this study.

Author information

Authors and Affiliations

  1. Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, NRW, Germany

    Yannik Hanusrichter, Carsten Gebert, Sven Frieler & Martin Wessling

  2. Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany

    Yannik Hanusrichter, Marcel Dudda, Jendrik Hardes, Arne Streitbuerger & Martin Wessling

  3. Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany

    Carsten Gebert

  4. Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, RUB, Bochum, Germany

    Sven Frieler

  5. Department of Trauma Surgery, University Hospital Essen, Essen, Germany

    Marcel Dudda, Jendrik Hardes & Arne Streitbuerger

  6. Department of Orthopedics and Trauma Surgery BG-Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Germany

    Marcel Dudda

  7. Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany

    Jendrik Hardes & Arne Streitbuerger

  8. Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK

    Lee Jeys

  9. Faculty of Health Sciences, Aston University, Birmingham, UK

    Lee Jeys

Authors
  1. Yannik Hanusrichter
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  2. Carsten Gebert
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  3. Sven Frieler
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  4. Marcel Dudda
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  6. Arne Streitbuerger
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  7. Lee Jeys
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  8. Martin Wessling
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Contributions

Y. Hanusrichter, MD: Conceptualization, data curation, investigation, methodology, formal analysis, resources, validation, writing—original draft.

C. Gebert, Prof: Conceptualization, investigation, methodology, project administration, resources, supervision, validation, writing—original draft

S. Frieler, MD: Investigation, validation, writing—review and editing.

M. Dudda, Prof.: Supervision, validation, writing—review and editing.

J. Hardes, Prof.: Conceptualization, supervision, validation, writing—review and editing.

A. Streitbuerger, Prof: Supervision, validation, writing—review and editing.

L. M. Jeys, Prof.: Conceptualization, supervision, validation, writing—review and editing

M. Wessling, MD: Conceptualization, data curation, formal analysis, investigation, methodology, validation, writing—original draft

Corresponding author

Correspondence to Yannik Hanusrichter.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University Essen-Duisburg, Essen, Germany (Date: 29.03.2022; reference number: 21–10438-KOBO). All patients agreed to participate in the study, giving informed consent and permission.

Consent to participate

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

Consent to publish

Consent to publish was obtained from all individual participants included in the study.

Competing interests

CG and MW have received research support not related to this publication from Implantcast GmbH, Buxtehude, Germany. JH and AS have received financial support for scientific projects not related to this publication from Implantcast GmbH, Buxtehude, Germany. YH, CG, JH, LJ, AS, and MW have received a speaker honorarium from Implantcast GmbH, Buxtehude, Germany. LJ has received speaker honorarium from Zimmer Biomet, Warsaw, IN, USA, and Stryker Corporation, Kalamazoo, MI, USA.

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Hanusrichter, Y., Gebert, C., Frieler, S. et al. Beyond type III Paprosky acetabular defects: are partial pelvic replacements with iliosacral fixation successful?. International Orthopaedics (SICOT) 47, 2253–2263 (2023). https://doi.org/10.1007/s00264-023-05823-9

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