Custom Triflange Acetabular Components for Revision Hip Arthroplasty in the Patients with Severe Acetabular Defects: Planning, Surgical Technique, Outcomes

Cover Page

Abstract

Employment of custom triflange acetabular components (CTAC) is one of the few options for pelvic reconstruction in the patients requiring complex acetabulum revisions with Paprosky 2 C, 3 A and 3 B defects and pelvic ring disruption.

The purpose of the study was to describe the features of planning, surgical technique, and short-term treatment outcomes of the patients with significant acetabular defects, in which the revision hip arthroplasty was performed using the CTAC.

Materials and Methods. A single-center analysis of a series of consecutive patients was performed: 50 complex acetabulum revisions in 47 patients (16 men and 31 women). The average age of the patients was 60±12 years (from 31 to 82; Me 62 years), the average body mass index was 29.7±6.3 kg/m2 (18.4 to 46.3; Me 29.0 kg/m).

Results. The mean follow-up was 22±13 months (from 3 to 3.6 years; Me 20 months). The average Harris score increased from 27±7 (from 15 to 39; Me 27) before surgery to 64±16 (from 22 to 90; Me 67) a year after (p<0.001). The level of pain according to VAS before surgery was 7±1 points (from 5 to 9; Me 7), after treatment it decreased to 2±1 points (from 0 to 7; Me 1, p<0.001). In 17 cases out of 50 (34%), there was at least one complication: dislocations — 7 (14%) cases; infection — 3 (6%); loosening — 2 (4%); complications associated with the femoral component — 4 (8%), including 3 intraoperative fractures and 1 postoperative, associated with loosening of the implant; pronounced disturbances of static and locomotor functions — 2 (4%). 12 cases out of 50 (24%) required another surgery, all of which were performed in a year. The Kaplan-Meyer survival rate for the hip implants was 0.71, for the CTAC — 0.87.

Conclusion. Employment of the CTAC for revision hip arthroplasty in the patients with significant acetabulum defects and pelvic ring disruption allows reliable fixation of the endoprosthesis components. The STAC placement technique is more anatomical than use of structural allografts, several augments or sup-cage systems. It allows reconstruction of extensive bone defects, theoretically avoiding the long-term problems with allografts, modular trabecular components, antiprotrusion systems and cup-cage. Although, to prove this, the longer follow-up is needed.

About the authors

A. A. Korytkin

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Andrey A. Korytkin — Cand. Sci. (Med.), Acting Director

Novosibirsk

Russian Federation

Ya. S. Novikova

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: novikova_jana@mail.ru

Yana S. Novikova — Cand. Sci. (Biol.), Researcher

Novosibirsk

Russian Federation

E. A. Morozova

Privolzhsky Research Medical University

Email: fake@neicon.ru

Ekaterina A. Morozova — Social Work Specialist

Nizhny Novgorod

Russian Federation

S. A. Gerasimov

Privolzhsky Research Medical University

Email: fake@neicon.ru

Sergey A. Gerasimov — Head of Adult Orthopedics Department

Nizhny Novgorod

Russian Federation

K. A. Kovaldov

Privolzhsky Research Medical University

Email: fake@neicon.ru

Kirill A. Kovaldov — Orthopedic Surgeon

Nizhny Novgorod

Russian Federation

Yo. M. El moudni

Ibn Rochd University Hospital

Email: fake@neicon.ru

Younes M. El moudni — Orthopedic Surgeon of Trauma and Orthopedic Surgery Department

Casablanca

Morocco

References

  1. Rossman S.R., Cheng E.Y. Reconstructing pelvic discontinuity and severe acetabular bone loss in revision hip arthroplasty with a massive allograft and cage. JBJS Essent Surg Tech. 2016;6(3):e30. doi: 10.2106/JBJS.ST.16.00026.
  2. Shon W.Y., Santhanam S.S., Choi J.W. Acetabular reconstruction in total hip arthroplasty. Hip Pelvis. 2016;28(1):1-14. doi: 10.5371/hp.2016.28.1.1.
  3. Makita H., Kerboull M., Inaba Y., Tezuka T., Saito T., Kerboull L. Revision total hip arthroplasty using the Kerboull acetabular reinforcement device and structural allograft for severe defects of the acetabulum. J Arthroplasty. 2017;32(11):3502-3509. doi: 10.1016/j.arth.2017.06.029.
  4. Löchel J., Janz V., Hipfl C., Perka C., Wassilew G.I. Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up. Bone Joint J. 2019;101-B(3):311-316. doi: 10.1302/0301-620X.101B3.BJJ-2018-0959.R1.
  5. Baauw M., van Hooff M.L., Spruit M. Current construct options for revision of large acetabular defects: A systematic review. JBJS Rev. 2016;4(11). pii: 10.2106/JBJS. RVW.15.00119. doi: 10.2106/JBJS.RVW.15.00119.
  6. Amenabar T., Rahman W.A., Hetaimish B.M., Kuzyk P.R., Safir O.A., Gross A.E. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res. 2016;474(2): 408-414. doi: 10.1007/s11999-015-4210-4.
  7. Abolghasemian M., Tangsaraporn S., Drexler M., Barbuto R., Backstein D., Safir O. et al. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in midterm. Bone Joint J. 2014;96-B:195-200. doi: 10.1302/0301-620X.96B2.31907.
  8. Berasi C.C., Berend K.R., Adams J.B., Ruh E.L, Lombardi A.V. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res. 2014;473(2):528-535. doi: 10.1007/s11999-014-3969-z.
  9. Barlow B.T., Oi K.K., Lee Y., Carli A.V., Choi D.S., Bostrom M.P. Outcomes of custom flange acetabular components in revision total hip arthroplasty and predictors of failure. J Arthroplasty. 2016;31(5):1057-1064. doi: 10.1016/j.arth.2015.11.016.
  10. Taunton M.J., Fehring T.K., Edwards P., Bernasek T., Holt G.E., Christie M.J. Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res. 2012;470(2):428-434. doi: 10.1007/s11999-011-2126-1.
  11. Коваленко А.Н., Шубняков И.И., Билык С.С., Тихилов Р.М. Современные технологии лечения тяжелых костных дефектов в области вертлужной впадины: какие проблемы решают индивидуальные имплантаты? Политравма. 2017;(1):72-81.
  12. Коваленко А.Н., Тихилов Р.М., Шубняков И.И., Билык С.С., Денисов А.О., Черкасов М.А., Ибрагимов К.И. Ревизии вертлужных компонентов индивидуальными конструкциями с минимальным сроком наблюдения 12 месяцев: функциональные результаты, качество жизни и удовлетворенность пациентов. Травматология и ортопедия России. 2019;25(1):21-31. doi: 10.21823/2311-2905-2019-25-1-21-31.
  13. Коваленко А.Н., Джавадов А.А., Шубняков И.И., Билык С.С., Денисов А.О., Черкасов М.А. и др. Среднесрочные результаты использования индивидуальных конструкций при ревизионном эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2019;25(3):37-46. doi: 10.21823/2311-2905-2019-25-3-37-46.
  14. Paprosky W.G., Perona P.G., Lawrence J.M. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33-44. doi: 10.1016/0883-5403(94)90135-x.
  15. D’Antonio J.A., Capello W.N., Borden L.S., Bargar W.L., Bierbaum B.F., Boettcher W.G. et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126-137. doi: 10.1097/00003086-198906000-00019.
  16. Dall’Ava L., Hothi H., Henckel J., Di Laura A., Shearing P., Hart A. Comparative analysis of current 3D printed acetabular titanium implants. 3D Print Med. 2019;5(1):15. doi: 10.1186/s41205-019-0052-0.
  17. Migaud H., Common H., Girard J., Huten D., Putman S. Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2019;105(1S):S53-S61. doi: 10.1016/j.otsr.2018.04.030.
  18. Dall’Ava L., Hothi H., Di Laura A., Henckel J., Hart A. 3D Printed acetabular cups for total hip arthroplasty: A review article. Metals. 2019;9(7):729. doi: 10.3390/met9070729.
  19. Bagaria V., Chaudhary K. A paradigm shift in surgical planning and simulation 3Dgraphy: experience of first 50 surgeries done using 3D-printed biomodels. Injury. 2017;48(11):2501-2508. doi: 10.1016/j. injury.2017.08.058.
  20. Berend M.E., Berend K.R., Lombardi A.V., Cates H., Faris P. The patient-specific triflange acetabular implant for revision total hip athroplasty in patients with severe acetabular defects: planning, implantation, and results. Bone Joint J. 2018;100-B (1 Supple A):50-54. doi: 10.1302/0301-620X.100B1.BJJ-2017-0362.R1.
  21. Kieser D.S., Ailabouni R., Kieser S.C.J., Wyatt M.C., Armour P.C., Coates M.H., Hooper G.J. The use of an ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up. Hip Int. 2018;28(6):668-674. doi: 10.1177/1120700018760817.
  22. Sypień P., Łęgosz P., Małdyk P. Use of three-dimensional printing and patient-matched implant in total hip arthroplasty – a case study. Ortop Traumatol Rehabil. 2019;21(3):207-211. doi: 10.5604/01.3001.0013.2935.
  23. Wang X., Xu H., Zhang J. Using personalized 3D printed titanium sleeve-prosthetic composite for reproximal femur in revision total hip arthroplasty: A case report. Medicine (Baltimore). 2020;99(3):e18784. doi: 10.1097/MD.0000000000018784.
  24. Barlow B.T., Oi K.K., Lee Y., Carli A.V., Choi D.S., Bostrom M.P. Outcomes of custom flange acetabular components in revision total hip arthroplasty and predictors of failure. J Arthroplasty. 2016;31(5):1057-1064. doi: 10.1016/j.arth.2015.11.016.
  25. Citak M., Kochsiek L., Gehrke T., Haasper C., Suero E.M., Mau H. Preliminary results of a 3D-printed acetabular component in the management of extensive defects. Hip Int. 2018;28(3):266-271. doi: 10.5301/hipint.5000561.
  26. Корыткин А.А., Захарова Д.В., Новикова Я.С., Горбатов Р.О., Ковалдов К.А., Эль Мудни Ю.М. Опыт применения индивидуальных трехфланцевых вертлужных компонентов при ревизионном эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2017;23(4):101-111. doi: 10.21823/2311-2905-2017-23-4-101-111.

Statistics

Views

Abstract: 325

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies