Potential use of a new fully porous multi-hole titanium acetabular component with cemented liner fixation

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Abstract

Background. 3D printing technology has found widespread use in the production of custom-made and mass-produced acetabular components. Since the end of 2022, a new fully porous acetabular component with multiple screw holes and cemented liner fixation has been available.

Research questions. In which clinical scenarios were the fully porous acetabular components used, and with which friction units? Which additional elements were used to achieve reliable primary fixation? What are the short-term survival rates of these implants and the functional outcomes of patients?

Methods. The new component was used in 106 patients between October 2023 and December 2024. There were 55 (51.9%) women and 51 (48.1%) men. The average age was 60.7 years. In 11 (10.4%) cases, implantation was performed in complex cases of primary hip arthroplasty; in 48 (45.3%) cases, during aseptic revisions; and in 47 (44.3%) cases, during the second stage of infection-related revision. In all cases, screws were used for fixation, the number of which ranged from 2 to 10, with an average of 5.5. In 38 (35.8%) cases, acetabular components were combined with augments and/or cup-cage systems. In 47 (44.3%) cases, dual mobility cement fixation systems were used as a friction unit; in the remaining cases, cemented polyethylene liners were used.

Results. The mean follow-up period was 14.1 months (range, 9-23 months). There were 18 (17.0%) complications, 10 of which required repeat revisions. Complications included 6 (5.7%) cases of infection, 5 (4.7%) cases of recurrent dislocations, 3 patients developing sciatic neuropathy, 2 cases of femoral component loosening, and 2 cases of periprosthetic fractures. No aseptic loosening of the acetabular component was observed.

Conclusions. The advantages of the new acetabular component include the possibility of extended screw fixation and the use of different bearing surfaces, including dual mobility. This ensures reliable primary fixation and reduces the risk of recurrent dislocations. The use of a fully porous titanium acetabular cup with a cemented liner in complex primary and revision hip arthroplasty has demonstrated good radiographic results and early survival with a minimum follow-up of 9 months.

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INTRODUCTION

Continuous improvements in implants for primary total hip arthroplasty (THA) contribute to excellent long-term outcomes with artificial joints, while the ongoing refinement of surgical techniques and optimization of instrumentation ensure a high reproducibility of component implantation quality [1, 2, 3]. However, in complex cases of primary THA and in revision surgery, implantation of an artificial joint may be substantially challenging [4, 5, 6]. In particular, in case of both primary and revision arthroplasty, the presence of acetabular bone defects [7, 8], as well as compromised or sclerotic bone, creates difficulties in achieving reliable primary fixation of the acetabular component and subsequent osseous integration, often necessitating the use of revision systems with options for enhanced screw fixation [9, 10, 11, 12]. In recent years, the proportion of implants manufactured using 3D printing has increased within the range of revision designs. This technology was initially widely adopted for the production of patient-specific implants and subsequently for the manufacture of serial acetabular components [1, 13, 14, 15]. Since the end of 2022, a new 3D-printed acetabular component has been produced in the Russian Federation — a fully porous design with multiple screw holes and cemented liner fixation. Advances in additive manufacturing have enabled relatively straight-forward production of cups with a high degree of porosity and pore sizes optimal for osseous integration with the underlying bone [16, 17, 18, 19], while the presence of numerous screw holes facilitates reliable primary fixation. In turn, cemented liner fixation optimizes the choice of the bearing articulation, ranging from highly cross-linked polyethylene to dual-mobility cups [20].

The present study addressed the following questions:

In which clinical scenarios were the fully porous acetabular components used, and with which friction units?

Which additional elements were used to achieve reliable primary fixation?

What are the short-term survival rates of these implants and the functional outcomes of patients?

METHODS

We present a series of 106 cases of implanta-tion of the Tuberlock Logeeks MS acetabular component (Novosibirsk, Russia) performed at our center by 22 surgeons between October 2023 and December 2024. The number of implantations performed by an individual surgeon ranged from 1 to 43. The majority of procedures — 73 (68.9%) — were performed by three surgeons.

Patients

The study cohort included 55 (51.9%) women and 51 (48.1%) men. The mean patient age was 60.7 years; the median (Me) was 64 years, with an interquartile range [Q1; Q3] from 52 to 71 years; the minimum and maximum values (min-max) were 27 and 81 years. The mean age of male patients was statistically significantly lower than that of female patients (p < 0.001).

In 11 cases (10.4%), these components were implanted in complex primary THA procedures; in 48 cases (45.3%), aseptic revision arthroplasty was performed; and in 47 cases (44.3%), patients underwent staged treatment of periprosthetic joint infection (conversion of a spacer to a definitive prosthesis) or had a history of revision surgery for infection. The mean patient age differed across these subgroups: 56.9 years in primary THA, 59.4 years in staged infection treatment, and 62.8 years in aseptic revisions. However, these differences were not statistically significant (p = 0.288) (Table 1). The structure of aseptic and infection-related revisions is pre-sented in Figure 1.

 

Table 1

Distribution of patients by age and causes of surgical intervention

Intervention

Number of patients

Mean age, years

n (%)

M

Me

Q1; Q3

Primary THA

11 (10.4)

56.9

60

51; 66

Revision THA

48 (45.3)

62.8

65

56; 71

Infection-related revisions

47 (44.3)

59.4

63

50; 69

Total

106 (100)

60.7

64

52; 71

 

Figure 1. Structure of revision procedures: a — aseptic; b — infection-related

 

Based on the analysis of preoperative pelvic X-rays, the type of acetabular defect was determined in the revision subgroup according to the W.G. Paprosky classification [21]. In the primary THA subgroup, acetabular defects were classified using a working classification [22], while the degree of dysplasia was assessed according to the extended G. Hartofilakidis clas-sification [23]. Implant positioning options, surgical details, and patients’ medical history were extracted from the electronic medical records.

Clinical and functional outcomes were assessed using follow-up X-rays (the signs of loosening included component migration, radiolucent lines, and screw failure), telephone interviews, and patient-reported questionnaires. Two patients were lost to follow-up due to incorrect telephone numbers recorded in the database. Two patients were contacted and information regarding their general condition and follow-up X-rays was obtained; however, these patients declined to complete the questionnaires. The remaining 102 patients provided complete data. Functional status was evaluated using the Oxford Hip Score (OHS). Pain intensity was assessed using the visual analogue scale (VAS), and overall satisfaction with the surgical outcome was measured using a 10-point scale, where 0 indicated complete dissatisfaction and 10 indicated complete satisfaction [24].

Statistical analysis

Statistical analysis was performed using SPSS Statistics 22 (IBM, USA). The normality of data distribution was assessed using the Shapiro-Wilk and Kolmogorov-Smirnov tests. In all cases, quantitative variables demonstrated non-normal distributions. Quantitative data were summarized using the mean (M), median (Me), lower and upper quartiles [Q1; Q3], as well as minimum and maximum values. Comparisons of quantitative variables between groups and subgroups were performed using the Mann-Whitney U test, while the Kruskal-Wallis test was applied for multiple group comparisons. Categorical data were analyzed using Pearson’s chi-square (χ²) test.

A p-value < 0.05 was considered statistically significant.

RESULTS

The mean follow-up duration was 14.1 months; the median was 13 [11; 16] months, with a minimum follow-up of 9 months and a maximum of 23 months. During this period, complications were recorded in 18 (17.0%) patients, requiring re-operations in 10 (9.4%) cases.

The most common complication in our series was infection, observed in 6 (5.7%) cases. Infections occurred more frequently in patients with a history of infection-related problems — 4 cases accounting for 3.8% of the entire cohort and 8.5% of patients who had previously undergone infection-related revisions or were treated within a staged infection protocol. The second most frequent complication was dislocation, observed in 5 (4.7%) cases, which was also more common among patients undergoing infection-related revisions. All three cases of sciatic nerve neuropathy were recorded in the aseptic revision subgroup, representing 2.8% of the overall cohort and 6.3% of the aseptic revision subgroup (Table 2). No cases of aseptic loosening of the acetabular component were observed during the follow-up period.

 

Table 2

Distribution of complications and re-operations by the type of procedure

Complication

Primary THA (n = 11)

Revision THA (n = 48)

Infection-related revisions (n = 47)

Total (n = 106)

n (%)

of which revised

n (%)

of which revised

n (%)

of which revised

n (%)

of which revised

Infection

–

–

2 (4.2)

–

4 (8.5)

4 (8.5)

6 (5.7)

4 (3.8)

Dislocations

1 (9.1)

1 (9.1)

–

–

4 (8.5)

1 (2.1)

5 (4.7)

2 (1.9)

Neuropathy

–

–

3 (6.3)

–

–

–

3 (2.8)

–

Loosening of the femoral component

–

–

1 (2.1)

1 (2.1)

1 (2.1)

1 (2.1)

2 (1.9)

2 (1.9)

Periprosthetic

fractures

–

–

2 (4.2)

2 (4.2)

–

–

2 (1.9)

2 (1.9)

Total

1 (9.1)

1 (9.1)

8 (16.7)

3 (6.3)

9 (19.1)

6 (12.8)

18 (17.0)

10 (9.4)

 

Analysis of X-rays

In revision THA, type IIIa defects were most common, identified in 38 (40.0%) cases, followed by type IIIb defects in 36 (37.9%) cases. A type IIIa defect in one case and type IIIb defects in two cases were associated with the disruption of the pelvic ring at the level of the acetabulum (pelvic discontinuity, PD). Less severe type II defects were more frequently observed in the infection-related revision subgroup — 15 (31.9%) cases — compared with aseptic revisions, in which such defects were identified in 6 (12.5%) cases (Table 3).

 

Table 3

Distribution of acetabular defect type according to the revision type, n (%)

Defect type

Revision THA (n = 48)

Infection-related revision (n = 47)

Total (n = 95)

IIa

2 (4.3)

1 (2.1)

3 (3.2)

IIb

2 (4.3)

8 (17.0)

10 (10.5)

IIc

1 (2.1)

7 (15.0)

8 (8.4)

IIIa

17 (35.4)

20 (42.6)

37 (38.9)

IIIa + PD

–

1 (2.1)

1 (1.1)

IIIb

24 (50.0)

10 (21.3)

34 (35.8)

IIIb + PD

2 (4.3)

–

2 (2.1)

Total

48 (100)

47 (100)

95 (100)

 

Only 11 patients underwent primary THA. Of these, 9 had a history of acetabular fractures with residual displacement (two cases classified as type 2C and seven as type 3 according to the working classification [22]). One patient under-went surgery for a high hip dislocation type C1 according to the Hartofilakidis classification [23], and in one case THA was performed for severe osteoradionecrosis complicated by PD.

In all cases, screws were used to achieve reli-able primary fixation of the acetabular systems, with the number of screws ranging from 2 to 10 (Me = 5 [4; 7]). In 38 (35.8%) cases, acetabular components were combined with augments and/or cup-cage systems. The distribution of the various combinations is presented in Table 4.

 

Table 4

Selection of additional fixation elements according to the clinical scenario

Procedure type

Defect type

1 augment

2 augments

BS

1 augment + BS

2 augments + BS

Mean number of screws

(min-max)

Primary THA

Sequelae of type 2C acetabular fracture

1

–

–

–

–

6 and 8

Sequelae of type 3 acetabular fracture

–

–

–

–

-

5.6 (4-7)

Dysplasia С1

1

–

–

–

-

6

Osteoradionecrosis + PD

1

–

–

–

-

10

Total

3

–

–

–

–

6.3 (4-10)

Revision THA

IIa

–

–

–

–

-

5.3 (4-7)

IIb

–

–

–

–

-

4.7 (3-6)

IIc

–

–

–

–

-

5.3 (3-7)

IIIa

8

–

1

–

-

5.5 (2-10)

IIIa + PD

1

–

–

–

-

7

IIIb

4

14

3

–

1

5.6 (2-10)

IIIb + PD

–

–

–

1

1

4 and 7

Total

13

14

4

1

2

5.5 (2-10)

Overall

16

14

4

1

2

5.5 (2-10)

BS — Burch-Schneider cage.

 

As the friction unit, various cemented dual-mobility systems were used in 47 (44.3%) cases. The number of dual-mobility constructs could potentially have been higher; however, their use was limited by size constraints. The minimum acetabular shell size allowing implantation of a 47-mm dual-mobility liner is 58 mm. In the remaining cases, various cemented polyethylene options were used, ranging from Müller cups to liners designed for different cementless components. The distribution of friction units across different clinical scenarios is presented in Tables 5 and 6. Dual-mobility systems were used significantly more often in infection-related revision cases (p < 0.001).

 

Table 5

Friction unit selection according to procedure type, n (%)

Procedure type

Polyethylene liner

Cemented dual-mobility cup

Total

Primary THA

9 (81.8)

2 (4.3)

11 (100.0)

Revision THA

36 (75.0)

12 (25.0)

48 (100.0)

Infection-related revision

14 (29.8)

33 (70.2)

47 (100.0)

Total

59 (55.7)

47 (44.3)

106 (100.0)

 

Table 6

Friction unit selection according to procedure type and defect type in revision THA, n (%)

Acetabular defect type

Polyethylene liner

Cemented dual-mobility cup

Total

IIa

–

3 (3.2)

3 (3.2)

IIb

3 (3.2)

7 (7.4)

10 (10.5)

IIc

1 (1.1)

7 (7.4)

8 (8.4)

IIIa

20 (21.1)

17 (17.9)

37 (38.9)

IIIa + PD

–

1 (1.1)

1 (1.1)

IIIb

24 (25.3)

10 (10.5)

34 (35.8)

IIIb + PD

2 (2.1)

–

2 (2.1)

Total

50 (52.6)

45 (47.4)

95 (100)

 

Clinical and functional outcomes

The level of patient satisfaction with the surgical outcomes was relatively high, with a mean score of 7.3 points, Me = 8 [7; 9]. Although two (1.9%) of the 104 patients reported complete dissatisfaction, 38 (36.6%) patients reported being completely satisfied. Slightly lower satisfaction scores were observed among patients undergoing infection-related revisions (6.9 points, Me = 7 [6; 9]) compared with those who underwent aseptic revisions (7.6 points, Me = 8 [7; 9]) and primary procedu-res (7.7 points, Me = 8 [6; 9]). However, these differences were not statistically significant (p = 0.15).

A marked reduction in pain intensity was observed postoperatively, with a mean postoperative VAS score of 2.14, Me = 3 [2; 4].

Clinical and functional outcomes assessed using the OHS were available for 102 (96.2%) patients. The mean OHS improved from 18 points preoperatively (Me = 20 [16; 24]) to 32 points (Me = 34 [30; 40]) at follow-up. Median postoperative OHS values were 36 [28; 42] in the primary THA group, 34 [30; 40] in the aseptic revision THA group, and 32 [22; 40] in the infection-related revision group. These differences were also not statistically significant (p = 0.094).

According to postoperative radiographic assessment at the time of follow-up, no signs of acetabular component loosening were detected in any case.

DISCUSSION

Total hip arthroplasty is considered by most authors to be one of the most effective surgical procedures, which has led to a steady annual increase in the number of operations performed [1, 10, 25, 26]. Unfortunately, the rapid growth of primary THA is likely accompanied by an expansion of indications and an increasing proportion of patients undergoing complex joint replacement, as well as by a rising frequency of these procedures in very young patients. In such cases, outcomes are less predictable, complication rates are substantially higher, and implant survival is reported to be only 75-85% at 10 years [5, 25, 27, 28, 29]. Consequently, the number of revision procedures continues to increase, with even higher complication rates and re-operation rates reaching up to 20-30% [1, 13, 25, 30].

According to most studies and large arthroplasty registries, aseptic loosening of prosthetic components remains one of the leading causes of revision surgery [20, 31]. However, a clear trend toward an increasing proportion of infection-related revisions has been reported. Such cases often require two or more revision stages and negatively affect both the quantity and the quality of bone stock in the acetabulum and femur [31]. In addition, the literature increasingly emphasizes that revision surgery and complex primary THA are frequently associated with defects whose severity cannot be adequately captured using the Paprosky classification alone [32, 33]. In such situations, a combination of features from different classification systems or assessment based on CT 3D-reconstructions may be required [34, 35, 36, 37].

Despite the complex primary pathology and substantial acetabular bone loss in the majority of revision cases, our cohort demonstrated relatively favorable short-term clinical and functional outcomes, including a marked reduction in pain intensity, a significant improvement in functional status, and high levels of patient satisfaction.

At the same time, the relatively high complication rate and the 9.4% re-operation rate at a mean follow-up of 14 months warrant further analysis and continued observation. It should be noted that most complications occurred in the most complex clinical scenarios, and in all cases were not related to the loss of acetabular component fixation. For example, the highest number of dislocations was observed in the infection-related revision group (4 of 5 cases). These events were likely attributable not to the design or positioning of the acetabular component, nor to the choice of friction unit, but rather to severe destruction of the proximal femur following removal of the femoral stem, resulting in pronounced muscular insufficiency (Figure 2).

 

Figure 2 (a, b, c, d, e, f, g, h). Increased risk of dislocation associated with muscle insufficiency resulting from radical excision of infected tissues during infection-related revision:

a, b — X-rays of a 60-year-old female patient following primary cemented total hip arthroplasty of the left hip performed for femoral neck fracture; c — fistulography of the right hip demonstrating contrast agent penetration into the joint cavity; d — pelvic X-ray after the 1st stage of infection-related revision — removal of prosthetic components and cement with subsequent implantation of an articulating spacer performed 3 months after the primary procedure; e — 3D reconstruction of the acetabular defect showing a Paprosky type IIIB defect combined with PD; f — pelvic X-ray after the 2nd stage of revision — implantation of a Tuberlock Logeeks MS cup secured with four screws and additional half-cage fixation of the superior part of the hemipelvis; g — during the postoperative period, dislocations associated with abductor muscle insufficiency occurred three times; h — 4 months later, a re-revision was performed, involving removal of the polyethylene component and insertion of a cemented dual-mobility cup

 

It is not surprising that dual-mobility components were used in 70.2% of infection-related revision cases, compared with 25.0% in aseptic revisions and only 4.3% in primary THA (p < 0.001). The increased risk of recurrent dislocation after infection-related revisions is supported by the literature and is apparently related to substantial proximal femoral bone loss during removal of well-fixed femoral components [38]. The likely mechanism underlying sciatic nerve neuropathy was traction due to significant acute limb lengthening, an event reported to occur in 7-8% of revision THA cases [39, 40].

Similarly, all other complications and the need for revisions were not attributable to the specific features of this acetabular component. On the contrary, in all cases its use allowed reliable primary fixation to be achieved, often through the extensive use of screws. Interestingly, the greatest number of screws was used in primary THA; however, all primary procedures were complex cases, and the need for additional fixation was determined intraoperatively by the surgeon. Cases involving fewer screws may reflect the surgeon’s deliberate choice or a limitation due to insufficient bone stock, for example when two augments (footing technique) were used (Figure 3).

 

Figure 3. Limitations of screw fixation when applying the footing technique: a, b — AP pelvic and lateral femoral X-rays of a 53-year-old patient showing aseptic loosening of both components of the left hip prosthesis 20 years after the primary procedure. Extensive osteolysis resulted in a contained acetabular defect (Paprosky type IIIb) with significant shortening of the left limb (> 3 cm); с — pelvic X-ray on the day after revision — two augments, connected with bone cement, were placed at the defect base, preventing the use of most screw holes of the Tuberlock Logeeks MS cup implanted over them. As a result, fixation was achieved only through peripheral holes; d — pelvic X-ray 1.5 years post-revision shows no radiographic signs of implant loosening

 

Overall, the presence of numerous peripherally located screw holes allows for extended screw fixation in the vast majority of cases. Nevertheless, there are some limitations. First, the porous surface area available for osseointegration is reduced. Second, all unused screw holes must be filled with morselized bone graft or wax to prevent cement intrusion at the interface between the cup’s porous surface and the host bone during liner implantation.

The effectiveness of highly porous cups has been well documented in numerous case series [41, 42, 43] and analyses of national registry data — large datasets demonstrate high survival of these constructs [44]. However, in complex primary and revision THA, available data are usually limited to relatively small case series [45, 46]. For example, a group from the Mayo Clinic reported on 30 cases of highly porous cups in patients with post-acetabular fracture sequelae, observing an 18% complication rate over 5 years (infections and dislocations), but no cases of aseptic loosening of the acetabular components [47]. In a study by H. Hosny et al., 63 patients undergoing revision THA with highly porous titanium cups were followed for 87 months, during which only one case of aseptic loosening was reported, yielding an acetabular component survival rate of 98.4% [48].

It should be noted that the main challenge following revision THA is the high risk of infection, particularly in patients with a prior history of infection [49, 50]. N. Quinlan et al. demonstrated that revisions after THA are associated with a 4-6-fold increased risk of subsequent periprosthetic joint infection within two years [51]. G. Renard et al., who studied microbiological cultures of biopsies obtained during aseptic revision THA, reported infection in 7% of cases and approximately 8% of cases with contamination [52]. The literature even discusses the potential role of extended antibiotic prophylaxis in cases of doubtful aseptic revision [53, 54, 55]. In our cohort, 4 of the 6 infection cases occurred in patients with a prior history of infection, representing an incidence of 8.5%, while the remaining two (4.2%) infection-related complications were observed in patients undergoing aseptic revisions. These rates may increase with longer follow-up.

A major advantage of this acetabular component is the ability to use polyethylene liners or dual-mobility systems from leading global manufacturers. This eliminates concerns regarding the quality of articulating surfaces, which determine the long-term performance of prosthetic joints, and allows for the implantation of constructs more resistant to dislocation, thereby reducing the risk of recurrent dislocations [56, 57, 58]. Additionally, cemented fixation of the friction unit allows for the use of antibiotic-loaded cement, which may have a beneficial effect in patients at increased risk for infection [59, 60, 61].

Overall, these components fulfilled their intended purpose, and the high number of complications reflects the complexity of the clinical scenarios.

The main conclusion of this study is that the use of a new fully porous 3D-printed titanium acetabular cup in complex primary and revision THA, in combination with a cemented cross-linked polyethylene (XLPE) liner or a cemented dual-mobility cup, as well as in conjunction with cup-cage and footing techniques, provides reliable fixation in the short term, regardless of the type of acetabular defect or the surgeon’s experience. Even in cases with minimal experience in using this system, no cases of aseptic loosening were observed in our cohort.

Study limitations

This study has several limitations. Strict indications for the use of these implants were not defined, and there is a considerable heterogeneity in the nature of bone defects, their etiology, and the technical solutions employed for combining different components. In addition, the study included a relatively small number of patients with a short follow-up period.

CONCLUSIONS

The use of a fully porous multi-hole titanium acetabular cup with a cemented liner in complex primary and revision total hip arthroplasty demonstrated good early survival and favorable radiographic outcomes, with a minimum follow-up of 9 months. This revision cup can likely be considered an effective option for patients undergoing complex primary or revision pro-cedures with moderate to severe acetabular bone loss. Given these promising short-term results, further studies are warranted to evaluate the long-term performance of these implants.

DISCLAIMERS

Author contribution

All authors made equal contributions to the study and the publication.

All authors have read and approved the final version of the manuscript of the article. All authors agree to bear responsibility for all aspects of the study to ensure proper consideration and resolution of all possible issues related to the correctness and reliability of any part of the work.

Funding source. This study was not supported by any external sources of funding.

Disclosure competing interests. The authors declare that they have no competing interests.

Ethics approval. Not applicable.

Consent for publication. Written consent was obtained from the patients for publication of relevant medical information and all of accompanying images within the manuscript.

Use of artificial intelligence. No generative artificial intelligence technologies were used in the preparation of this manuscript.

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About the authors

Igor I. Shubnyakov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: shubnyakov@mail.ru
ORCID iD: 0000-0003-0218-3106
SPIN-code: 3531-7679

Dr. Sci. (Med.)

Russian Federation, St. Petersburg

Andrey A. Korytkin

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: andrey.korytkin@gmail.com
ORCID iD: 0000-0001-9231-5891
SPIN-code: 2273-2241

Cand. Sci. (Med.), Associate Professor

Russian Federation, Novosibirsk

Aymen Riahi

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: riahi_aymen@outlook.com
ORCID iD: 0000-0001-8407-5453
SPIN-code: 9432-9359

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Alexey O. Denisov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: med-03@yandex.ru
ORCID iD: 0000-0003-0828-7678
SPIN-code: 2084-8670

Dr. Sci. (Med.)

Russian Federation, St. Petersburg

Alisagib A. Dzhavadov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: alisagib.dzhavadov@mail.ru
ORCID iD: 0000-0002-6745-4707
SPIN-code: 8591-6977

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Rashid M. Tikhilov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: rtikhilov@gmail.com
ORCID iD: 0000-0003-0733-2414
SPIN-code: 3602-4912

Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

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2. Figure 1. Structure of revision procedures: a — aseptic; b — infection-related

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3. Figure 2 (a, b, c, d, e, f, g, h). Increased risk of dislocation associated with muscle insufficiency resulting from radical excision of infected tissues during infection-related revision: a, b — X-rays of a 60-year-old female patient following primary cemented total hip arthroplasty of the left hip performed for femoral neck fracture; c — fistulography of the right hip demonstrating contrast agent penetration into the joint cavity; d — pelvic X-ray after the 1st stage of infection-related revision — removal of prosthetic components and cement with subsequent implantation of an articulating spacer performed 3 months after the primary procedure; e — 3D reconstruction of the acetabular defect showing a Paprosky type IIIB defect combined with PD; f — pelvic X-ray after the 2nd stage of revision — implantation of a Tuberlock Logeeks MS cup secured with four screws and additional half-cage fixation of the superior part of the hemipelvis; g — during the postoperative period, dislocations associated with abductor muscle insufficiency occurred three times; h — 4 months later, a re-revision was performed, involving removal of the polyethylene component and insertion of a cemented dual-mobility cup

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4. Figure 3. Limitations of screw fixation when applying the footing technique: a, b — AP pelvic and lateral femoral X-rays of a 53-year-old patient showing aseptic loosening of both components of the left hip prosthesis 20 years after the primary procedure. Extensive osteolysis resulted in a contained acetabular defect (Paprosky type IIIb) with significant shortening of the left limb (> 3 cm); с — pelvic X-ray on the day after revision — two augments, connected with bone cement, were placed at the defect base, preventing the use of most screw holes of the Tuberlock Logeeks MS cup implanted over them. As a result, fixation was achieved only through peripheral holes; d — pelvic X-ray 1.5 years post-revision shows no radiographic signs of implant loosening

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