What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?

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Abstract

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.

Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.

Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p<0.05) and its uncontained defects (p<0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p<0.05) and in the early stages of observation (p<0.05).

Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

About the authors

R. M. Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Rashid M. Tikhilov — Dr. Sci. (Med.), Professor, Director; professor, Traumatology and Orthopedics Department,

St. Petersburg

Russian Federation

A. A. Dzhavadov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: alisagib.dzhavadov@mail.ru

Alisagib A. Dzhavadov — Research Assistant

St. Petersburg

Russian Federation

A. N. Kovalenko

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Anton N. Kovalenko — Cand. Sci. (Med.), Researcher

St. Petersburg

Russian Federation

A. O. Denisov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Alexey O. Denisov — Cand. Sci. (Med.), Academic Secretary

St. Petersburg

Russian Federation

A. S. Demin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Alexander S. Demin — clinical resident

St. Petersburg

Russian Federation

A. G. Vahramyan

Shengavit Medical Center

Email: fake@neicon.ru

Arsen G. Vahramyan — Head of Traumatology and Orthopedics Service

Yerevan

Armenia

I. I. Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics;
St. Petersburg State Pediatric Medical University

Email: fake@neicon.ru

Igor I. Shubnyakov — Deputy Director; Professor of Department of Hospital Surgery

St. Petersburg

Russian Federation

References

  1. Pivec R., Johnson A.J., Mears S.C., Mont M.A. Hip arthroplasty. Lancet. 2012;380(9855):1768-1777. doi: 10.1016/S0140-6736(12)60607-2.
  2. Kurtz S.M, Roder C., Lau E., et al. International survey of primary and revision total hip replacement. Paper #365. Presented at the 56th Annual Meeting of the Orthopaedic Research Society. March 6-9, 2010. New Orleans. Available from: https://www.ors.org/Transactions/56/0365.pdf.
  3. Шубняков И.И., Тихилов Р.М., Денисов А.О., Ахмедилов М.А., Черный А.Ж., Тотоев З.А. и др. Что изменилось в структуре ревизионного эндопротезирования тазобедренного сустава в последние годы? Травматология и ортопедия России. 2019;25(4):9-27. doi: 10.21823/2311-2905-2019-25-4-9-27.
  4. Kowalik T.D., DeHart M., Gehling H., Gehling P., Schabel K., Duwelius P. et al. The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States. J Am Acad Orthop Surg. 2016;24(6):393-398. doi: 10.5435/JAAOS-D-15-00596.
  5. Yoon P.W., Lee Y.K., Ahn J., Jang E.J., Kim Y., Kwak H.S. et al. Epidemiology of hip replacements in Korea from 2007 to 2011. J Korean Med Sci. 2014;29(6):852-858. doi: 10.3346/jkms.2014.29.6.852.
  6. Jafari S.M., Coyle C., Mortazavi S.M., Sharkey P.F., Parvizi J. Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop Relat Res. 2010;468(8):2046-2051. doi: 10.1007/s11999-010-1251-6.
  7. Bozic K.J., Kamath A.F., Ong K., Lau E., Kurtz S., Chan V. Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA. Clin Orthop Relat Res. 2015;473(6);2131-2138. doi: 10.1007/s11999-014-4078-8.
  8. Badarudeen S., Shu A.C., Ong K.L., Baykal D., Lau E., Malkani A.L. Complications after revision total hip arthroplasty in the medicare population. J Arthroplasty. 2017;32(6):1954-1958. doi: 10.1016/j.arth.2017.01.037ю
  9. Мурылев В.Ю., Петров Н.В., Рукин Я.А., Елизаров П.М., Калашник А.Д. Ревизионное эндопротезирование вертлужного компонента эндопротеза тазобедренного сустава. Кафедра травматологии и ортопедии. 2012;(1):20-25.
  10. Волокитина Е.А., Хабиб М.С. Эндопротезирование тазобедренного сустава при деформациях и дефектах вертлужной впадины (обзор литературы). Уральский медицинский журнал. 2018;(1):56-63.
  11. 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.
  12. Тихилов Р.М., Шубняков И.И., Денисов А.О. Классификации дефектов вертлужной впадины: дают ли они объективную картину сложности ревизионного эндопротезирования тазобедренного сустава? (критический обзор литературы и собственных наблюдений). Травматология и ортопедия России. 2019;(1):122-141. doi: 10.21823/2311-2905-2019-25-1-122-141.
  13. 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.
  14. Telleria J.J., Gee A.O. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471(11):3725-3730. doi: 10.1007/s11999-013-3264-4.
  15. Yu R., Hofstaetter J.G., Sullivan T., Costi K., Howie D.W., Solomon L.B. Validity and reliability of the Paprosky acetabular defect classification. Clin Orthop Relat Res. 2013;471(7):2259-2265. doi: 10.1007/s11999-013-2844-7.
  16. Gozzard С., Blom A., Taylor A., Smith E., Learmonth I. A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery. J Arthroplasty. 2003;18(5):638-642. doi: 10.1016/s0883-5403(03)00107-4.
  17. Gross A., Allan D., Catre M., Garbuz D., Stockley I. Bone grafts in hip replacement surgery. The pelvic side. Orthop Clin North Am. 1993;24(4);679-695.
  18. Saleh K.J., Holtzman J., Gafni ASaleh L., Jaroszynski G., Wong P., Woodgate I. et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19(1):50-56. doi: 10.1016/S0736-0266(00)00021-8.
  19. 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.
  20. Sheth N.P., Melnic C.M., Brown N., Sporer S.M., Paprosky W.G. Two-centre radiological survivorship of acetabular distraction technique for treatment of chronic pelvic discontinuity: mean five-year follow-up. Bone Joint J. 2018;100-B(7):909-914. doi: 10.1302/0301-620X.100B7. BJJ-2017-1551.R1.
  21. Claus A.M., Engh C.A. Jr., Sychterz C.J., Xenos J.S., Orishimo K.F., Engh C.A. Sr. Radiographic definition of pelvic osteolysis following total hip arthroplasty. J Bone Joint Surg Am. 2003;85(8):1519-1526. doi: 10.2106/00004623-200308000-00013.
  22. Safir O., Lin C., Kosashvili Y., Mayne I.P., Gross A.E., Backstein D. Limitations of conventional radiographs in the assessment of acetabular defects following total hip arthroplasty. Can J Surg. 2012;55(6):401-407. doi: 10.1503/cjs.000511.
  23. von Roth P., Abdel M.P., Harmsen W.S., Berry D.J. Uncemented jumbo cups for revision total hip arthroplasty: a concise follow-up, at a mean of twenty years, of a previous report. J Bone Joint Surg Am. 2015;97(4):284-287. doi: 10.2106/JBJS.N.00798.
  24. Moon J.-K., Ryu J., Kim Y., Yang J.-H., Hwang K.-T., Kim Y.H. Acetabular revision arthroplasty using pressfitted jumbo cups: an average 10-year follow-up study. Arch Orthop Trauma Surg. 2019;139(8):1149-1160. doi: 10.1007/s00402-019-03214-7.
  25. 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.
  26. Schreurs B.W., Keurentjes J.C., Gardeniers J.W., Verdonschot N., Slooff T.J., Veth R.P. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented acetabular component: a 20- to 25-year follow-up. J Bone Joint Surg Br. 2009;91(9):1148-1153. doi: 10.1302/0301-620X.91B9.21750.
  27. Gilbody J., Taylor C., Bartlett G.E., Whitehouse S.L., Hubble M.J., Timperley A.J. et al. Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement: a minimum ten-year follow-up study. Bone Joint J. 2014;96-B(2):188-194. doi: 10.1302/0301-620X.96B2.32121.
  28. Павлов В.В., Пронских А.А., Мамуладзе Т.З., Базлов В.А., Ефименко М.В., Жиленко В.Ю. и др. Лечение пациента с обширным постимплантационным дефектом костей таза. Травматология и ортопедия России. 2018;(3): 125-134. doi: 10.21823/2311-2905-2018-24-3-125-134.
  29. Pierannunzii L., Zagra L. Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty. EFORT Open Rev. 2017;1(12):431-439. doi: 10.1302/2058-5241.160025.
  30. Park K.S., Seon J.K., Lee K.B., Kim S.K., Chan C.K., Yoon T.R. Revision Total Hip Arthroplasty Using an Acetabular Reinforcement Ring With a Hook: A Precise Follow-Up, at Average 11.4 Years, of a Previous Report. J Arthroplasty. 2017;32(2):503-509. doi: 10.1016/j.arth.2016.07.010.
  31. Marongiu G., Podda D., Mastio M., Capone A. Longterm results of isolated acetabular revisions with reinforcement rings: a 10- to 15-year follow-up. Hip Int. 2019;29(4):385-392. doi: 10.1177/1120700018802750.
  32. Корыткин А.А., Новикова Я.С., Ковалдов К.А., Королёв С.Б., Зыкин А.А., Герасимов С.А. и др. Среднесрочные результаты ревизионного эндопротезирования тазобедренного сустава с использованием ацетабулярных аугментов. Травматология и ортопедия России. 2019;(1):9-18. doi: 10.21823/2311-2905-2019-25-1-9-18.
  33. O’Neill C.J., Creedon S.B., Brennan S.A., O’Mahony F.J., Lynham R.S., Guerin S. et al. Acetabular Revision Using Trabecular Metal Augments for Paprosky Type 3 Defects. J Arthroplasty. 2018;33(3):823-828. doi: 10.1016/j.arth.2017.10.031.
  34. Sculco P.K., Ledford C.K., Hanssen A.D., Abdel M.P., Lewallen D.G. The Evolution of the Cup-Cage Technique for Major Acetabular Defects: Full and Half Cup-Cage Reconstruction. J Bone Joint Surg Am. 2017;99(13):1104-1110. doi: 10.2106/JBJS.16.00821.
  35. Hipfl C., Janz V., Löchel J., Perka C., Wassilew G.I. Cupcage reconstruction for severe acetabular bone loss and pelvic discontinuity: Mid-term Results of a Consecutive Series of 35 Cases. Bone Joint J. 2018;100-B(11):1442-1448. doi: 10.1302/0301-620X.100B11.BJJ-2018-0481.R1.
  36. Paprosky W.G., O’Rourke M., Sporer S.M. The treatment of acetabular bone defects with an associated pelvic discontinuity. Clin Orthop Relat Res. 2005;(441):216-220. doi: 10.1097/01.blo.0000194311.20901.f9.
  37. Mäkinen T.J., Kuzyk P., Safir O.A., Backstein D., Gross A.E. Role of cages in revision arthroplasty of the acetabulum. J Bone Joint Surg Am. 2016;98(3):233-242. doi: 10.2106/JBJS.O.00143.
  38. Gallart X., Fernández-Valencia J.A., Riba J., Bori G., García S., Tornero E., Combalía A. Trabecular TitaniumTM clinical results, radiology and survival outcomes. Hip Int. 2016;26(5):486-491. doi: 10.5301/hipint.5000378.
  39. Stiehl J.B., Saluja R., Diener T. Reconstruction of major column defects and pelvic discontinuity in revision total hip arthroplasty. J Arthroplasty. 2000;15(7):849-857. doi: 10.1054/arth.2000.9320.
  40. Paprosky W.G., Sekundiak T.D. Total acetabular allografts. Instr Course Lect. 1999;48:67-76.
  41. Paprosky W., Sporer S., O’Rourke M.R. The treatment of pelvic discontinuity with acetabular cages. Clin Orthop Relat Res. 2006;(453):183-187. doi: 10.1097/01.blo.0000246530.52253.7b.
  42. Kosashvili Y., Backstein D., Safir O., Lakstein D., Gross A.E. Acetabular revision using an antiprotrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg Br. 2009;91(7):870-876. doi: 10.1302/0301-620X.91B7.22181.
  43. DeBoer D.K., Christie M.J., Brinson M.F., Morrison J.C. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am. 2007;89(4):835-840. doi: 10.2106/JBJS.F.00313.
  44. De Martino I., Strigelli V., Cacciola G., Gu A., Bostrom M.P., Sculco P.K. Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty. 2019;34(10):2511-2518. doi: 10.1016/j.arth.2019.05.032.
  45. Taunton M.J., Fehring T.K., Edwards P., Bernasek T., Holt G.E., Christie M.J. Pelvic Discontinuity Treated With Custom Triflange Component. Clin Orthop Relat Res. 2012;470(2):428-434. doi: 10.1007/s11999-011-2126-1.
  46. Kieser D.C., Ailabouni R., Wyatt M.C., Armour P.C., Coates M.H. et al. 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.
  47. Jafari S.M., Bender B., Coyle C., Parvizi J., Sharkey P.F., Hozack W.J. Do tantalum and titanium cups show similar results in revision hip arthroplasty? Clin Orthop Relat Res. 2010;468(2):459-465. doi: 10.1007/s11999-009-1090-5.
  48. Wind M.A. Jr., Swank M.L., Sorger J.I. Shortterm results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics. 2013;36(3):e260-265. doi: 10.3928/01477447-20130222-11.
  49. Friedrich M.J., Schmolders J., Michel R.D., Randau T.M., Wimmer M.D., Kohlhof H. et al. Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop. 2014;38(12):2455-2461. doi: 10.1007/s00264-014-2443-6.
  50. Berasi C.C. 4th, Berend K.R., Adams J.B., Ruh E.L., Lombardi A.V. Jr. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res. 2015;473(2):528-535. doi: 10.1007/s11999-014-3969-z.
  51. Barlow B.T., Oi K.K., Lee Y.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.
  52. Baauw M., van Hellemondt G.G., Spruit M. A Custom-made Acetabular Implant for Paprosky Type 3 Defects. Orthopedics. 2017;40(1):e195-e198. doi: 10.3928/01477447-20160902-01.
  53. Gladnick B.P., Fehring K.A., Odum S.M., Christie M.J., DeBoer D.K., Fehring T.K. Midterm Survivorship After Revision Total Hip Arthroplasty With a Custom Triflange Acetabular Component. J Arthroplasty. 2018;33(2):500-504. doi: 10.1016/j.arth.2017.09.026.
  54. Myncke I., van Schaik D., Scheerlinck T. Custom-made triflanged acetabular components in the treatment of major acetabular defects. Short-term results and clinical experience. Acta Orthop Belg. 2017;83(3):341-350.
  55. Moore K.D., McClenny M.D., Wills B.W. Custom Triflange Acetabular Components for Large Acetabular Defects: Minimum 10-Year Followup. Orthopedics. 2018;41(3):e316-e320. doi: 10.3928/01477447-20180213-11.
  56. Chiarlone F., Zanirato A., Cavagnaro L., Alessio-Mazzola M., Felli L., Burastero G. Acetabular custommade implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg. 2020;140(3): 415-424. doi: 10.1007/s00402-020-03334-5.170

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