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Clinical and radiological survivorship of the Thackray cross plate with rim reinforcement ring for cemented acetabular revision

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Acetabular component revision surgery can be a challenging task due to the encountered bone defects. Both cemented and uncemented techniques are described. We report on the survivorship of the Thackray cross plate with rim reinforcement ring for cemented acetabular revision.

Patients and methods

This is a retrospective case series of all patients treated with the implant with a minimum follow-up of 2 years. Acetabular defects were characterized according to the Paprosky classification. Data on potential risk factors for failure of the construct as well as the Oxford Hip Score (OHS) were collected. Kaplan–Meier survival analysis with radiographic aseptic loosening or revision for aseptic loosening as the end point was performed.

Results

From 2000 to 2017, 35 revisions in 18 male and 17 female patients with an average age of 72 years were included. Bone allograft was used in 26 cases and additional implants (medial or supero-lateral mesh) in 13. Seven patients have deceased and the fate of all revisions is known. At an average clinical follow-up of 9.7 (2.6 to 19.6) years, there were no further re-revisions for construct failure. Five hips have demonstrated radiological evidence of aseptic loosening. Radiologically loose components were associated with more severe grades of acetabular bone defects (Paprosky Type 3) (60% vs 3%, p = 0.006). Kaplan–Meier survival analysis demonstrates 79.8% overall survivorship at 7 years. Survivorship for Type 2 defects was significantly higher compared to Type 3 (90% vs 0% at 7 years, Logrank test p = 0.002, Cox proportional hazards p = 0.03). The final median OHS was 38 (12–48) and was not affected by component loosening.

Conclusion

This is a cost-effective device that protects the underlying bone graft (81% complete remodeling) and prevents subsidence of the cemented cup (2 mm on average). It should be used with caution in high-grade defects and perhaps not advised.

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Acknowledgements

We would like to acknowledge Stephanie Waspe and Mary Wright, Research Facilitators, for their work maintaining the local joint registry and contributing to data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Trauma and Orthopaedics, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke, RG24 9NA, Hampshire, UK

    Leonidas Roumeliotis, Saadallah G. Haidar, Christopher M. Jordan, Jamie T. Griffiths, Toby W. Briant-Evans & Geoffrey J. Stranks

  2. Department of Trauma and Orthopaedics, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK

    Christopher M. Jordan

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  1. Leonidas Roumeliotis
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  2. Saadallah G. Haidar
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Correspondence to Leonidas Roumeliotis.

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Conflict of interest

The department receives financial research support from Zimmer Biomet and United Orthopaedics Corporate. The department receives financial support from DePuy Synthes to fund the position of a Clinical Fellow. One of the authors is a paid speaker at DePuy Synthes events.

Ethics approval

Ethical approval was waived by the National Healthcare System (NHS) Health Research Authority (HRA) on-line Decision Tool in view of the retrospective nature of the study and all the procedures being performed as part of routine care.

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 3a, b. The requirement for additional informed consent to be obtained in retrospect has been waived, due to the anonymized retrospective nature of the study.

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Roumeliotis, L., Haidar, S.G., Jordan, C.M. et al. Clinical and radiological survivorship of the Thackray cross plate with rim reinforcement ring for cemented acetabular revision. Arch Orthop Trauma Surg 140, 1825–1835 (2020). https://doi.org/10.1007/s00402-020-03590-5

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