Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery

Abstract

Purpose

Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures.

Method

We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months.

Result

Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6–18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points.

Conclusion

Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Peterson CA, Lewallen DG (1996) Periprosthetic fracture of the acetabulum after total hip arthroplasty. J Bone Joint Surg Am 78(8):1206–1213

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Mc Elfresh EC, Coventry MB (1974) Femoral and pelvic fractures after total hip arthroplasty. J Bone Joint Surg 56A:483–492

    Article  Google Scholar 

  3. 3.

    Berry et al (1999) Epidemiology of periprosthetic fracture after major joint replacement: hip and knee. Orthop Clin North Am 30:183–190

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Mears DC, Velyvis JH (2001) Primary total hip arthroplasty after acetabular fracture. Instr Course Lect 50:335–354

    CAS  PubMed  Google Scholar 

  5. 5.

    Helfet DL, Ali A (2004) Periprosthetic fractures of the acetabulum. Instr Course Lect 53:93–98

    PubMed  Google Scholar 

  6. 6.

    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(4):780–785

    PubMed  Google Scholar 

  7. 7.

    O’Shea K, Quinlan JF, Kutty S, Mulcahy D, Brady OH (2005) The use of uncemented extensively porous-coated femoral components in the management of Vancouver B2 and B3 periprosthetic femoral fractures. J Bone Joint Surg Br 87(12):1617–1621

    Article  PubMed  Google Scholar 

  8. 8.

    Della Valle CJ, Momberger NG, Paprosky WG (2003) Periprosthetic fractures of the acetabulum associated with a total hip arthroplasty. Instr Course Lect 52:281–290

    PubMed  Google Scholar 

  9. 9.

    Nilsdotter A, Bremander A (2011) Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken) 63(Suppl 11):S200–S207. doi:10.1002/acr.20549

    Article  Google Scholar 

  10. 10.

    Masri BA, Meek RM, Duncan CP (2004) Periprosthetic fractures evaluation and treatment. Clin Orthop Relat Res 420:80–95

    Article  Google Scholar 

  11. 11.

    Mitchell PA, Greidanus NV, Masri BA, Garbuz DS, Duncan CP (2003) The prevention of periprosthetic fractures of the femur during and after total hip arthroplasty. Instr Course Lect 52:301–308

    PubMed  Google Scholar 

  12. 12.

    Telleria JJ, Gee AO (2013) Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res 471(11):3725–3730. doi:10.1007/s11999-013-3264-4

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Hall Eilers M, Hansen R, Robinson BS, Maloney WJ, Paprosky WG et al (2014) Advances in acetabular reconstruction in revision total hip arthroplasty: maximizing function and outcomes after treatment of periacetabular osteolysis around the well-fixed shell. Instr Course Lect 63:209–218

    PubMed  Google Scholar 

  14. 14.

    Pierannunzii L, Fischer M, Tagliabue L, Calori GM, d’Imporzano M (2010) Acetabular both-column fractures: essentials of operational management. Injury 41(11):1145–1149. doi:10.1016/j.injury.2010.08.011

    Article  PubMed  Google Scholar 

  15. 15.

    Benazzo F, Formagnana M, Bargagliotti M, Perticarini L (2015) Periprosthetic acetabular fractures. Int Orthop 39(10):1959–1963. doi:10.1007/s00264-015-2971-8

    Article  PubMed  Google Scholar 

  16. 16.

    Butterwick D, Papp S, Gofton W, Liew A, Beaulé PE (2015) Acetabular fractures in the elderly: evaluation and management. J Bone Joint Surg Am 97(9):758–768. doi:10.2106/JBJS.N.01037

    Article  PubMed  Google Scholar 

  17. 17.

    Sheth NP, Melnic CM, Paprosky WG (2014) Acetabular distraction: an alternative for severe acetabular bone loss and chronic pelvic discontinuity. J. Bone Joint 96-B(11 Suppl A):36–42. doi:10.1302/0301-620X.96B11.34455

    CAS  Article  Google Scholar 

  18. 18.

    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 Arthroplast 20(8):1002–1009

    Article  Google Scholar 

  19. 19.

    Levine B (2008) A new era in porous metals: applications in orthopedics. Adv Eng Mater 10(9):788–792

    CAS  Article  Google Scholar 

  20. 20.

    Barbella M (2008) Materials marvels: Titanium is a top choice for implants, but other materials are gaining popularity. Orthopaedic Design & Technology, September 1

  21. 21.

    Zhang Y et al (1999) Interfacial frictional behavior: cancellous bone, cortical bone, and a novel porous tantalum biomaterial. J Musculoskel Res 3(4):245–251

    Article  Google Scholar 

  22. 22.

    Weeden SH, Schmidt RH (2007) The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplast 22(6 Suppl 2):151–155

    Article  Google Scholar 

  23. 23.

    Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ (1999) Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 81(5):907–914

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Karageorgiou V, Kaplan D (2005) Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials 26(27):5474–5491

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Macheras GA, Papagelopoulos PJ, Kateros K, Kostakos AT, Baltas D, Karachalios TS (2006) Radiological evaluation of the metal-bone interface of a porous tantalum monoblock acetabular component. J Bone Joint Surg Br 88(3):304–309

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Gruen TA, Poggie RA, Lewallen DG, Hanssen AD, Lewis RJ, O’Keefe TJ, Stulberg SD, Sutherland CJ (2005) Radiographic evaluation of a monoblock acetabular component: a multicenter study with 2- to 5-year results. J Arthroplast 20(3):369–378

    Article  Google Scholar 

  27. 27.

    Macheras G, Kateros K, Kostakos A, Koutsostathis S, Danomaras D, Papagelopoulos PJ (2009) Eight- to ten-year clinical and radiographic outcome of a porous tantalum monoblock acetabular component. J Arthroplast 24(5):705–709. doi:10.1016/j.arth.2008.06.020

    Article  Google Scholar 

  28. 28.

    Tsiridis E, Pavlou G, Venkatesh R, Bobak P, Gie G (2009) Periprosthetic femoral fractures around hip arthroplasty: current concepts in their management. Hip Int 19(2):75–86

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to L. Meccariello.

Ethics declarations

Conflict of interest

Gabriele Falzarano, Antonio Piscopo, Giuseppe Rollo, Antonio Medici, Predrag Grubor, Michele Bisaccia, Valerio Pipola, Raffaele Cioffi, Francesco Nobile and Luigi Meccariello disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations and grants or other funding.

Human and animal rights

This type of study does not require any statement relating to studies on humans and animals. All patients gave the informed consent prior to being included into the study. All procedures involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Falzarano, G., Piscopo, A., Rollo, G. et al. Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery. Musculoskelet Surg 102, 87–92 (2018). https://doi.org/10.1007/s12306-017-0503-y

Download citation

Keywords

  • Paprosky acetabular classification
  • Tantalum
  • Bone loss
  • Hip revision surgery
  • Acetabular periprosthetic fractures
  • Outcomes