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1
Udintseva, M. Yu, E. A. Volokitina, D. A. Kolotygin, and S. M. Kutepov. "Compensation of acetabular defects in primary and revision hip arthroplasty." Genij Ortopedii 30, no. 6 (2024): 797–810. https://doi.org/10.18019/1028-4427-2024-30-6-797-810.
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Introduction Total hip arthroplasty in defects of the acetabulum is a complex type of surgical intervention, and the search for optimal implants and bone substituting materials to restore the integrity of the acetabulum is one of the current problems. The aim of the work was to analyze the results of primary and revision hip arthroplasty with compensation of acetabulum defects.Materials and methods The study material consisted of 93 patients with primary (65) and revision (28) total hip arthroplasty in the presence of bone defects of the acetabulum of varying severity. To systematize primary defects, the classification of the American Association of Orthopedic Surgeons (AAOS, 2017) was used; for defects in revision surgeries, the classification of W.G. Paprosky (1994) was used. Clinical, radiological, and statistical study methods were used. The results of managing bone defects of the acetabulum with various methods of compensation were studied. The Harris Hip Score (HHS), 1969, was used to assess the function of the involved joints.Results Depending on the type of acetabular defects, an algorithm was developed for choosing a bone grafting method for acetabular defects and implanting the cup. The best results were observed for cases of a combination of resorbable and non-resorbable bone graft materials and cementless fixation of the pelvic component. A clinical example of three consecutive revision interventions on one hip joint in a patient with bilateral dysplastic coxarthrosis is presented.Discussion The most widely used method of bone grafting in primary arthroplasty is plastic surgery with autologous chips from the femoral head. In significant bone tissue loss, one of the plastic surgery options is a structural auto- or allograft, the use of which allows restoring the rotation center and forming a bone support for possible future revisions; poor results with this method are caused by allograft lysis. In revision arthroplasty on the hip joint in large defects, plastic surgery of the defect is performed with crushed or structural allograft bone. An antiprotrusion constructs or cups made of trabecular metal are installed; in instability of the pelvic ring, osteosynthesis of the posterior column is required. Trabecular metal structures feachuring high porosity and adhesion to bone and the elastic modulus close to bone tissue provide conditions for optimal primary and secondary fixation of the component.Conclusion Long-term and painless functioning of the hip joint after arthroplasty performed for acetabular defects is possible with restoration of the spherical shape of the acetabulum and the center of joint rotation in the true acetabulum, adequate elimination of bone tissue loss, reliable primary fixation of the cup with provision of conditions due to restoration and osteointegration. Acetabular defects are diverse in their anatomical manifestations, which create difficulties in choosing pelvic components, augments, and the method of their fixation to the pelvic bone. Based on the type of the acetabular defect, an algorithm has been developed for choosing a method for acetabular bone defect filling and implanting a cup.
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Patel, Dipesh Kumar, Md Mohtashemul Haque, and C. H. Mohamed Afsal. "Bony Acetabular Reconstruction in Total Hip Arthroplasty – Our Experience." Journal of Orthopaedic Diseases and Traumatology 7, no. 1 (2024): 103–7. http://dx.doi.org/10.4103/jodp.jodp_34_24.
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Abstract Background: Most of the revision hip arthroplasties have some sort of acetabular bone defects. These defects are usually managed with some sort of metal augments. These metal augments might make the bone weaker and fragile and revisions may become difficult. Aim of Study: This study aimed to study the outcome of various types of acetabular defects managed with bone grafts. Materials and Methods: Ten patients with acetabular defects requiring separate management planning (Paprosky classification of acetabular defect) for total hip arthroplasty from May 2020 to May 2021 were selected and followed for further 2 years. Results: Acetabular defect was classified preoperatively with three-dimensional computed tomography scan. In all the cases, the bone graft healed radiographically with no signs of loosening of the acetabular cup. Conclusion: Conservative acetabular revision (reconstruction of the bone defect with bone graft) is the need of the hour. Reconstruction by bone graft has a smooth learning curve.
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Udintseva, Maria Yu, Elena A. Volokitina, and Sergey M. Kutepov. "Compensation of acetabular defects in hip arthroplasty." Kazan medical journal 103, no. 1 (2022): 89–99. http://dx.doi.org/10.17816/kmj2022-89.
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Acetabular reconstruction is a necessary condition for improving the survival rate and proper functioning of the implant. The issue of compensation for bone loss remains one of the most difficult and controversial in orthopaedics. The article aimed to analyze approaches to the problem of management of acetabular defects in hip replacement. The paper presents the key features of the anatomy and radiological anatomy of the acetabulum. Modern modifications of acetabular components of an endoprosthesis, their advantages and disadvantages, as well as ways to compensate for acetabular bone loss with bone substitute materials are considered. The review highlights the use of 3Dprinting technologies, the interaction between physicians and other experts in this field. Currently, an active search for materials, alternatives to autogenous bone, as well as ways to facilitate the design and reduce the negative impact of the implant on the patient's bone tissue continues. The use of additive technologies seems to be the most promising direction that allows applying an individual approach to each clinical case, but it is available only in specialized centres and is associated with significant material, technical and legal difficulties. Stable fixation of the acetabular component, according to the literature, is achieved under the condition of restoration of hip rotation centre in the native acetabulum area, restoration of normal anatomical relations in the hip joint and adequate replacement of bone loss.
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Martynenko, D. V., V. P. Voloshin, L. A. Sherman, K. V. Shevyrev, S. A. Oshkukov, and E. V. Stepanov. "Assessment of Acetabulum Deformity During Preoperative Planning for Hip Arthroplasty." Traumatology and Orthopedics of Russia 25, no. 3 (2019): 153–64. http://dx.doi.org/10.21823/2311-2905-2019-25-3-153-164.
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Purpose of the study — to improve the two-dimensional planning of total hip joint arthroplasty to ensure precise positioning of the acetabular component in the deformed acetabulum. Materials and methods. Features of roentgenological anatomy of acetabulum and its coverage were studied on 1058 hip joint x-rays in the AP view in accordance with the procedure developed by the authors to define acetabular square — the site of standard positioning of a spherical femoral head in the acetabulum or of a hemispherical acetabular component. The method consisted of identifying the apex of “teardrop” figure; the most lateral points of the pelvic terminal line and roof of the acetabulum; superior part of the acetabular cavity; medial and inferior points of acetabular coverage, and building the sides of acetabular square — medial, inferior, lateral and superior boundary lines. Connection of “teardrop” apex and lateral point of the pelvic terminal line formed the medial side of acetabular square, and a perpendicular to that line drawn through the “teardrop” apex to its inferior side. The lateral side was drawn either through the intersection of the ascending diagonal line — bisector from the top of the “teardrop” figure with the contour of the acetabulum roof, or was a part of the projection of the most lateral point of the acetabular roof on the inferior side of the square. The superior side was a perpendicular connecting the intersection of the ascending diagonal and lateral bounding lines with the medial side of the acetabular square. The area of the deformed acetabular cavity located outside of the acetabular square was assessed as the acetabular defect. Results. Method of defining the acetabular square allowed to identify types of ratios between acetabular cavity and acetabular coverage in transverse (9 types) and longitudinal (7 types) direction. Combination of transverse ratio of acetabular cavity and coverage with longitudinal type allowed to define the options of acetabular deformities in two-dimensional view. The authors identified 25 types of acetabular deformities. Bone defects of acetabular walls were of the major importance among all anatomical features. Cranial defect of acetabulum was observed in 450 cases, medial wall defect — in 38 cases, defect including cranial and medial areas — in 7 cases. Conclusion. The method suggested by the authors to determine acetabular square and acetabular deformity variations allows to screen the anatomical features of the acetabulum during two-dimensional preoperative planning and to make an informed decision on the need to use other planning techniques. The type of acetabular deformity identified during preoperative planning allows to elaborate the indications for replacement of acetabular bone defects and/or resection of acetabular osteophytes.
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Golnik, V. N., V. A. Peleganchuk, D. A. Dzhukhaev, Yu M. Batrak, and V. V. Pavlov. "Impaction bone grafting as a method of choice in bone defect management in the revision hip arthroplasty: a cases series." Genij Ortopedii 30, no. 2 (2024): 245–54. http://dx.doi.org/10.18019/1028-4427-2024-30-2-245-254.
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Introduction Reconstruction of the acetabulum during revision arthroplasty is a challenging task in the setting of massive bone defects. Often the only effective method is impaction bone grafting (IBG). The purpose is to demonstrate the capabilities of the X-Change impaction bone grafting technology in replacing acetabular defects as a method of choice for revision hip arthroplasty.Materials and methods In the presented series of cases, the use (IBG) turned out to be the method of choice, allowing for high-quality reconstruction. In each presented case, revision hip arthroplasty was performed with augmentation with a reconstructive mesh or trabecular metal augment to create support and contain the defect to retain the osteoplastic material.Results During follow-up periods of 4.8 to 6.5 years there were no signs of resorption or loosening. According to the Harris hip score the results were 96, 97 and 89 points respectively.Discussion Impaction bone grafting technology is quite versatile. It can be used in various coditions of revision arthroplasty with contained defects of the acetabulum. In contrast to the use of modular revision augmentation systems and additive technologies it makes possible to achieve dense filling of the smallest defects and profile a bed congruent with the acetabular component. The use of cemented fixation makes it possible to further stabilize the impacted bone chips and use mechanotransduction mechanisms that stimulate the bone remodeling. The use of IBG has proven to be an effective technique for the reconstruction of medium-sized acetabular defects in combination with mesh and cement cup, as well as in combination with trabecular metal augments.Conclusion The use of IBG during revision hip arthroplasty can be especially effective for small acetabulum sizes. Combining IBG with trabecular metal augments significantly expands the application of this technology. The use of IBG makes it possible to create a bone reserve, which creates more favorable conditions for inevitable repeated revision interventions.
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Li, Pengyu, Hao Tang, Xiaoyu Liu, et al. "Reconstruction of severe acetabular bone defects with porous metal augment in total hip arthroplasty: A finite element analysis study." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 236, no. 2 (2021): 179–87. http://dx.doi.org/10.1177/09544119211052377.
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This study aims to evaluate the reconstructive stability for Paprosky III acetabular defects after total hip arthroplasty using three different reconstruction strategies with trabecular metal (TM) augments. The acetabular bone defects examined were located in the ilium, the sciatic ramus and the pubic ramus. Different scenarios of acetabular reconstructions were simulated, including the non-reconstruction model (NRM), the complete reconstruction model (CRM), the two-point reconstruction model (TRM) and the superior edge reconstruction model (SRM). A primary hip replacement model (HRM) was also investigated to compare the initial stability with different reconstruction models. The gait cycle was incorporated in the model to investigate the dynamic variation within the contact mechanics parameters. By comparing the SRM and the TRM, the acetabular cup translation was more pronounced when the superior defect on the acetabulum remained unfixed. Comparison of the acetabular cup displacement and the interface micromotion of both HRM and CRM demonstrated that the prosthetic implant provided good support for the reconstructed acetabulum. With the use of a press-fit cup, the cup displacement was reduced remarkably, while its Von-Mises stress increased significantly. The results show that the CRM was the best reconstruction option. In terms of acetabular defects, future improvements should focus on the reconstructive stability in stress concentration areas, to ensure no significant stress-shielding or other factors contributing to loosening of the prosthesis.
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Rozhkov, N. I., A. M. Ermakov, A. S. Triapichnikov, and N. V. Sazonova. "Treatment of patients with periprosthetic infection and management of Paprosky type 2C cavitary defects at the stage of articulating spacer installation." Genij Ortopedii 30, no. 5 (2024): 706–16. http://dx.doi.org/10.18019/1028-4427-2024-30-5-706-716.
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Introduction Due to the constant increase in the number of primary and revision hip arthroplasties, the incidence of complications has been also increasing. Periprosthetic joint infection (PJI) is the most common and dangerous complication in joint arthroplasty, including PJI with cavitary defects of the acetabulum (Paprosky type 2C).The purpose of the work was to demonstrate successful results of managing acetabular defects in patients with periprosthetic infection at the stage of installing an articulating spacer.Materials and methods The patients underwent surgical management of cavitary defects of the acetabulum with allobone plastic material at the stage of installation of an articulating spacer impregnated with antibacterial drugs. A clinical and functional assessment of the effectiveness of treatment of patients with PJI of the hip joint, who underwent bone grafting of acetabular defects at the first stage of two-stage revision arthroplasty, was carried out. Remission of the infectious process was assessed according to the ICM 2013 (International Consensus Meeting), and the function of the affected limb was assessed according to the HHS (Harris Hip Score).Results At a 6-month follow-up after implantation, there were no clinical and laboratory manifestations of PJI and radiological signs of instability of the implant components. Bone grafting was evaluated to be satisfactory; the function of the affected joint restored to 80–90 to HHS points. Remission of the infectious process according to ICM was achieved.Discussion Clinical cases studied demonstrate a positive result of treatin PJI with plastic surgery of cavitary defects of the acetabular bottom at the stage of articulating spacer installation. Filling acetabular defects at the sanitizing stage (implantation of a spacer) subsequently provides improvement of primary fixation and osseointegration of the acetabular component when converting the spacer to a permanent implant. This is due to an increase in the contact area of the acetabular component with bone tissue (native bone and remodeled allobone material).Conclusion The treatment of the first clinical case improved joint function from 24 to 85 HHS points, and in the second from 27 to 76 HHS points. The use of defect filling techniques enabled to stop the infection and improve functional results.
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Bondarenko, S. Ye, S. A. Denisenko, M. Yu Karpinsky, and O. V. Yaresko. "Investigation of the effect of porous titanium cups on stress distribution in bone tissue (mathematical modeling)." TRAUMA 22, no. 3 (2021): 28–37. http://dx.doi.org/10.22141/1608-1706.3.22.2021.236320.
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Introduction. During arthroplasty in patients with altered anatomy and osteoporosis of the acetabulum, stable fixation of the acetabular component of the endoprosthesis is a very difficult task. There are studies on the bone tissue bonding to titanium, tantalum and ceramic coatings of endoprostheses. However, there are insufficient data on the influence of the strength characteristics of modern surfaces of the cups for hip endoprostheses on the distribution of mechanical stresses in the bone tissue around the implanted components. The purpose was to study on a mathematical model the changes in the stress-strain state of the endoprosthesis-bone system as a result of using porous tantalum cup. Materials and methods. A mathematical modeling has been carried out of the stress-strain state of the human hip joint in arthroplasty with porous cup. Du-ring the study, a defect in the acetabular roof filled with a bone implant fixed with two screws was simulated, as well as a defect in the acetabular floor filled with bone “chips”. Endoprosthesis cups were modeled in two versions: from solid titanium with a spray coating of porous titanium, and those entirely made of porous titanium. A distributed load of 540 N was applied to the sacrum. A load was applied between the iliac wing and the greater trochanter of the femur simulating the action of the gluteus medius — 1150 N and the gluteus minimus — 50 N. Results. The use of a cup with a coating of porous titanium in the normal state of the acetabulum leads to the occurrence of maximum stresses (15.9 MPa) in its posterior-upper part. Minimum stresses of 4.6 MPa are observed in the center of the acetabulum. The use of an endoprosthesis with porous titanium cup allows reducing the level of stresses in the bone tissue around the cup. If there is a defect in the acetabular roof, a hip endoprosthesis with porous titanium cup causes less stress than a solid titanium cup with coating of porous titanium. But on the graft, the stress level remains practically unchanged, regardless of the type of cup. The use of porous tantalum cup in the presence of a defect in the acetabular floor causes significantly less stress in the bone tissue around it, compared to an all-metal cup with coating. Conclusions. The cup of the hip endoprosthesis made of porous titanium causes significantly less stress in all control points of the model, compared to a cup made of solid titanium with coating of porous titanium, both with defects in the acetabular roof and floor, and without bone defects.
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Chen, Hou-Tsung, Cheng-Ta Wu, Tsan-Wen Huang, Hsin-Nung Shih, Jun-Wen Wang, and Mel S. Lee. "Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up." BioMed Research International 2018 (2018): 1–7. http://dx.doi.org/10.1155/2018/2364269.
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Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.
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Galuzinskii, Olexander, Volodymyr Chornyi, Yevhenii Kozik, and Yevhenii Fedin. "TOTAL HIP JOINT REPLACEMENT USING A CUSTOM TRIFLANGE ACETABULAR COMPONENT (LITERATURE REVIEW)." Wiadomości Lekarskie 76, no. 12 (2023): 2694–99. http://dx.doi.org/10.36740/wlek202312120.
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The aim: The purpose of the article is to analyze the ways of solving the problem of revision hip joint replacement. The article discusses the methods of treatment using a custom triflange acetabular component. Materials and methods: The analysis of 37 literary sources includes a discussion of the features of the use of individual triflange acetabular components and errors in revision hip arthroplasty, which are associated with various factors. Conclusions: A review of studies devoted to the use of custom triflange acetabular components confirms the effectiveness in the early postoperative period in the treatment of critical acetabular defects and pelvic ring discontinuity. The CTAC use is particularly relevant in case of the pelvic ring disintegration, as it provides for the appropriate endoprosthesis adaptation with the healthy bone, as well as for the bone defects plastics and recovery of the hip joint biome¬chanics. So, the use of individual constructions is indicated for the patients with significant bone mass loss, where augment adaptation and adjustment is impossible. This method is used more often when there is no other alternative. Research results showed a trend that special three-flange components of the acetabulum have better long-term results compared to traditional standard components for large bone defects. Improving production and increasing the number of CTACs should reduce their cost. In summary, the custom triflange acetabulum components provide a personalized secure fit that can reduce the risk of complications and improve patient outcomes. In summary, the triple-flange acetabulum components provide a personalized secure fit that can reduce the risk of complications and improve patient outcomes.
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Tikhilov, R. M., A. A. Dzhavadov, A. N. Kovalenko, et al. "What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?" Traumatology and Orthopedics of Russia 26, no. 2 (2020): 31–49. http://dx.doi.org/10.21823/2311-2905-2020-26-2-31-49.
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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.
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Fröschen, Frank Sebastian, Thomas Martin Randau, El-Mustapha Haddouti, et al. "Three-Dimensional Assessment of the Biological Periacetabular Defect Reconstruction in an Ovine Animal Model: A µ-CT Analysis." Bioengineering 12, no. 7 (2025): 729. https://doi.org/10.3390/bioengineering12070729.
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The increasing number of acetabular revision total hip arthroplasties requires the evaluation of alternative materials in addition to established standards using a defined animal experimental defect that replicates the human acetabular revision situation as closely as possible. Defined bone defects in the load-bearing area of the acetabulum were augmented with various materials in an ovine periacetabular defect model (Group 1: NanoBone® (artificial hydroxyapatite-silicate composite; Artoss GmbH, Germany); Group 2: autologous sheep cancellous bone; Group 3: Tutoplast® (processed allogeneic sheep cancellous bone; Tutogen Medical GmbH, Germany)) and bridged with an acetabular reinforcement ring of the Ganz type. Eight months after implantation, a μ-CT examination (n = 8 animals per group) was performed. A μ-CT analysis of the contralateral acetabula (n = 8, randomly selected from all three groups) served as the control group. In a defined volume of interest (VOI), bone volume (BV), mineral volume (MV), and bone substitute volume (BSV), as well as the bone surface (BS) relative to the total volume (TV) and the surface-to-volume ratio (BS/BV), were determined. To assess the bony microarchitecture, trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and trabecular number (Tb.N), as well as connectivity density (Conn.D), the degree of anisotropy (DA), and the structure model index (SMI), were evaluated. The highest BV was observed for NanoBone® (Group 1), which also showed the highest proportion of residual bone substitute material in the defect. This resulted in a significant increase in BV/TV with a significant decrease in BS/BV. The assessment of the microstructure for Groups 2 and 3 compared to Group 1 showed a clear approximation of Tb.Th, Tb.Sp, Tb.N, and Conn.D to the microstructure of the control group. The SMI showed a significant decrease in Group 1. All materials demonstrated their suitability by supporting biological defect reconstruction. NanoBone® showed the highest rate of new bone formation; however, the microarchitecture indicated more advanced bone remodeling and an approximate restoration of the trabecular structure for both autologous and allogeneic Tutoplast® cancellous bone when using the impaction bone grafting technique.
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Jones, Stephen A., Jack Parker, and Matthew Horner. "Can a reconstruction algorithm in major acetabular bone loss be successful in revision hip arthroplasty?" Bone & Joint Journal 106-B, no. 5 Supple B (2024): 47–53. http://dx.doi.org/10.1302/0301-620x.106b5.bjj-2023-0809.r1.
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AimsThe aims of this study were to determine the success of a reconstruction algorithm used in major acetabular bone loss, and to further define the indications for custom-made implants in major acetabular bone loss.MethodsWe reviewed a consecutive series of Paprosky type III acetabular defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical acetabular component. IIIB defects were planned to receive either a hemispherical acetabular component plus augments, a cup-cage reconstruction, or a custom-made implant. We used national digital health records and registry reports to identify any reoperation or re-revision procedure and Oxford Hip Score (OHS) for patient-reported outcomes. Implant survival was determined via Kaplan-Meier analysis.ResultsA total of 105 procedures were carried out in 100 patients (five bilateral) with a mean age of 73 years (42 to 94). In the IIIA defects treated, 72.0% (36 of 50) required a porous metal augment; the remaining 14 patients were treated with a hemispherical acetabular component alone. In the IIIB defects, 63.6% (35 of 55) underwent reconstruction as planned with 20 patients who actually required a hemispherical acetabular component alone. At mean follow-up of 7.6 years, survival was 94.3% (95% confidence interval 97.4 to 88.1) for all-cause revision and the overall dislocation rate was 3.8% (4 of 105). There was no difference observed in survival between type IIIA and type IIIB defects and whether a hemispherical implant alone was used for the reconstruction or not. The mean gain in OHS was 16 points. Custom-made implants were only used in six cases, in patients with either a mega-defect in which the anteroposterior diameter > 80 mm, complex pelvic discontinuity, and massive bone loss in a small pelvis.ConclusionOur findings suggest that a reconstruction algorithm can provide a successful approach to reconstruction in major acetabular bone loss. The use of custom implants has been defined in this series and accounts for < 5% of cases.Cite this article: Bone Joint J 2024;106-B(5 Supple B):47–53.
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Marongiu, Giuseppe, Antonio Campacci, and Antonio Capone. "Quantitative Assessment of Acetabular Defects in Revision Hip Arthroplasty Based on 3D Modeling: The Area Increase Ratio (AIR) Method." Bioengineering 11, no. 4 (2024): 341. http://dx.doi.org/10.3390/bioengineering11040341.
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The most common classifications for acetabular bone defects are based on radiographic two-dimensional imaging, with low reliability and reproducibility. With the rise of modern processing techniques based on 3D modelling, methodologies for the volumetric quantification of acetabular bone loss are available. Our study aims to describe a new methodology for the quantitative assessment of acetabular defects based on 3D modelling, focused on surface analysis of the integrity of the main anatomical structures of the acetabulum represented by four corresponding sectors (posterior, superior, anterior, and medial). The defect entity is measured as the area increase ratio (AIR) detected in all the sectors analyzed on three planes of view (frontal, sagittal, and axial) compared to healthy hemipelvises. The analysis was performed on 3D models from the CT-scan of six exemplary specimens with a unilateral pathological hemipelvis. The AIR between the native and the pathological hemipelvis was calculated for each sector, for a total of 48 analyses (range, +0.93–+171.35%). An AIR of >50% were found in 22/48 (45.8%) sectors and affected mostly the posterior, medial, and superior sectors (20/22, 90.9%). Qualitative analysis showed consistency between the data and the morphological features of the defects. Further studies with larger samples are needed to validate the methodology and potentially develop a new classification scheme.
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Akel, İbrahim, Ömür Cağlar, A. Mazhar Tokgözoğlu, and Bülent Atilla. "Titanium cage reconstruction of acetabular defects in revision hip arthroplasty results in favourable outcomes: up to 17 years follow-up." HIP International 30, no. 5 (2019): 617–21. http://dx.doi.org/10.1177/1120700019855870.
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Introduction: Titanium cages are valuable implant solutions in management of severe acetabular defects during total hip revisions. We aimed to report clinical and radiological results of our cases in which we used titanium cages for reconstruction of acetabular defects. Methods: Patients underwent titanium cage reconstruction and bone grafting for their acetabular defects with minimum 2 year-follow-up are included to the study. Analysis of patient records, modified Hospital for Special Surgery hip score and radiological examinations on plain X-rays were evaluated. Acetabular defects are classified according to Paprosky’s classification. Kaplan Meier survival analysis is performed. Results: Fifty-six hips of 54 patients (2 bilateral) aged between 29-79 (mean 57 years ) are followed up for 7.06 years ±3.72 (2-17 years). Five patients required revision surgeries at a mean of 2.6±2.2 years. Kaplan Meier’s analysis revealed a survival rate of 91,5 % and mean revision free duration was 15,66±0,56 years. HSS scores of the patients before revision surgery yielded a mean score of 27,9 ± 4,9 (14-38). HSS scores at final follow up showed a significant improvement at a mean score of 45,9 ± 7 (28-56) differences were statistically significant, p<0,001) Discussion: Titanium cages are successful for restoring bone stock in severe acetabular defects. It is critical to pay attention on meticulous bone grafting of the presented defects and obtain good hip mechanics during cage insertion. Mechanical reasons are the leading cause of failure in long term but restoration of the bone stock and improvement in defect severity were regularly observed even in failed cages.
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Citak, Mustafa, Lilly Kochsiek, Thorsten Gehrke, Carl Haasper, Eduardo M. Suero, and Hans Mau. "Preliminary results of a 3D-printed acetabular component in the management of extensive defects." HIP International 28, no. 3 (2017): 266–71. http://dx.doi.org/10.5301/hipint.5000561.
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Introduction: The treatment of extensive bone loss and massive acetabular defects can be compounded by several challenges and pitfalls. The survivorship following acetabular revision with extensive bone loss is still unsatisfactory. The goal of the present study was to analyse the outcomes of 3D-printed patient-specific acetabular components in the management of extensive acetabular defects and combined pelvic discontinuity (PD). Methods: 9 patients underwent revision THA using 3D-printed custom acetabular components to reconstruct extensive acetabular defects. The Paprosky classifications were determined in all patients. The primary outcome measure was the implant-associated failure rate. Results: 1 out of 9 patients suffered an implant-associated complication (11%). The overall implant-associated survival rate was 89%. The overall complication rate was 56%. Conclusions: The patient-specific acetabular component technique shows promise for the treatment of patients with severe acetabular defects in revision THA. Further research aimed at reducing costs and improving the complication rate are warranted.
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Callary, Stuart A., Demien Broekhuis, Jessica Barends, et al. "Virtual biomechanical assessment of porous tantalum and custom triflange components in the treatment of patients with acetabular defects and pelvic discontinuity." Bone & Joint Journal 106-B, no. 5 Supple B (2024): 74–81. http://dx.doi.org/10.1302/0301-620x.106b5.bjj-2023-0852.r1.
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AimsThe aim of this study was to compare the biomechanical models of two frequently used techniques for reconstructing severe acetabular defects with pelvic discontinuity in revision total hip arthroplasty (THA) – the Trabecular Metal Acetabular Revision System (TMARS) and custom triflange acetabular components (CTACs) – using virtual modelling.MethodsPre- and postoperative CT scans from ten patients who underwent revision with the TMARS for a Paprosky IIIB acetabular defect with pelvic discontinuity were retrospectively collated. Computer models of a CTAC implant were designed from the preoperative CT scans of these patients. Computer models of the TMARS reconstruction were segmented from postoperative CT scans using a semi-automated method. The amount of bone removed, the implant-bone apposition that was achieved, and the restoration of the centre of rotation of the hip were compared between all the actual TMARS and the virtual CTAC implants.ResultsThe median amount of bone removed for TMARS reconstructions was significantly greater than for CTAC implants (9.07 cm3 (interquartile range (IQR) 5.86 to 21.42) vs 1.16 cm3 (IQR 0.42 to 3.53) (p = 0.004). There was no significant difference between the median overall implant-bone apposition between TMARS reconstructions and CTAC implants (54.8 cm2 (IQR 28.2 to 82.3) vs 56.6 cm2 (IQR 40.6 to 69.7) (p = 0.683). However, there was significantly more implant-bone apposition within the residual acetabulum (45.2 cm2 (IQR 28.2 to 72.4) vs 25.5 cm2 (IQR 12.8 to 44.1) (p = 0.001) and conversely significantly less apposition with the outer cortex of the pelvis for TMARS implants compared with CTAC reconstructions (0 cm2 (IQR 0 to 13.1) vs 23.2 cm2 (IQR 16.4 to 30.6) (p = 0.009). The mean centre of rotation of the hip of TMARS reconstructions differed by a mean of 11.1 mm (3 to 28) compared with CTAC implants.ConclusionIn using TMARS, more bone is removed, thus achieving more implant-bone apposition within the residual acetabular bone. In CTAC implants, the amount of bone removed is minimal, while the implant-bone apposition is more evenly distributed between the residual acetabulum and the outer cortex of the pelvis. The differences suggest that these implants used to treat pelvic discontinuity might achieve short- and long-term stability through different biomechanical mechanisms.Cite this article: Bone Joint J 2024;106-B(5 Supple B):74–81.
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Zagorodniy, N. V., G. A. Chragyan, O. A. Aleksanyan, S. V. Kagramanov, and E. V. Polevoy. "3D MODELLING AND PRINTING IN PRIMARY AND REVISION ARTHROPLASTY." N.N. Priorov Journal of Traumatology and Orthopedics 25, no. 2 (2018): 21–29. http://dx.doi.org/10.32414/0869-8678-2018-2-21-29.
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Introduction. Acetabular arthroplasty in patients with the abnormal pelvic bone anatomy is a challenging task. In recent years the method of 3D modelling and printing of custom acetabular components is widely used at acetabular arthroplasty in patients with marked bone defects.Purpose of study: to evaluate the accuracy, convenience of the positioning and efficacy of the primary stabilization of custom acetabular components in patients with bone defects at primary and revision hip arthroplasty. Patients and methods. Eighteen surgical interventions using 3D modelling and printing, i.e. 12 for hip instability, 6 — for posttraumatic coxarthrosis were performed. The study included 9 women and 9 men with mean age 60.9±15.8 years. By Paprosky classification in 2 cases the defects corresponded to Type I, in1 case — Type IIA, in 4 cases — Type IIB (posttraumatic coxarthrosis), in 2 cases — Type IIIA, in 10 — Type IIIB out of them 2 cases with pelvic bone separation. Custom components were produced using the method of direct metal laser sintering (DMLS). The whole technologic process took from 4 to 8 weeks and was conducted jointly with the engineers. Results. Exact match of implant form and the defect was observed in 89.9% of cases. In 2 patients with pelvic bone separation additional correction of bone structures was required when placing the acetabular component. In radiograph from 2 to 8 months after surgery the constructions were stable.Conclusion. 3D technology for the custom-made acetabular components is a method of resolving the problem in patients with marked acetabular defects. It enables to plan the surgery, simplifies the choice for screws positioning avoiding their interference. The design features of the implant are three rigid flanges with screw holes that create additional contact with intact parts of the ischial, iliac and pubic bones. Screw fixation ensures initial rigid stability until the biological fixation is achieved.
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McPherson, Edward J., Alexandra I. Stavrakis, Madhav Chowdhry, Nora L. Curtin, Matthew V. Dipane, and Brooke M. Crawford. "Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects." Bone & Joint Open 3, no. 12 (2022): 991–97. http://dx.doi.org/10.1302/2633-1462.312.bjo-2022-0094.r1.
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Aims Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects. Methods We performed a retrospective review at a single institution of patients undergoing revision THA by a single surgeon. We identified 49 consecutive patients with large acetabular defects where the biphasic BGS was applied, with no other products added to the BGS. After placement of metallic acetabular implants, the BGS was injected into the remaining bone defects surrounding the new implants. Patients were followed and monitored for functional outcome scores, implant fixation, radiological graft site remodelling, and revision failures. Results Mean follow-up was 39.5 months (36 to 71), with a significant improvement in post-revision function compared to preoperative function. Graft site remodelling was rated radiologically as moderate in 31 hips (63%) and strong in 12 hips (24%). There were no cases of complete graft site dissolution. No acetabular loosening was identified. None of the patients developed clinically significant heterotopic ossification. There were twelve reoperations: six patients developed post-revision infections, three experienced dislocations, two sustained periprosthetic femur fractures, and one subject had femoral component aseptic loosening. Conclusion Our series reports bone defect restoration with the sole use of a biphasic injectable BGS in the periacetabular region. We did not observe significant graft dissolution. We emphasize that successful graft site remodelling requires meticulous recipient site preparation. Cite this article: Bone Jt Open 2022;3(12):991–997.
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Zhou, Z. "RECONSTRUCTION OF PAPROSKY TYPE III ACETABULAR BONE DEFECTS IN REVISION HIP ARTHROPLASTY USING A COMBINATION OF CAGE AND MORSELIZED ALLOGRAFTS." Orthopaedic Proceedings 106-B, SUPP_16 (2024): 50. http://dx.doi.org/10.1302/1358-992x.2024.16.050.
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The management of severe acetabular bone defects poses a complex challenge in revision hip arthroplasty. Although biological fixation materials are currently dominant, cage has played an important role in complex acetabular revision in the past decades, especially when a biological prosthesis is not available. The purpose of this study is to report the long-term clinical and radiographic results of Paprosky type Ⅲ acetabular bone defects revised with cage and morselized allografts.We retrospectively analyzed 45 patients who underwent revision hip arthroplasty with cage and morselized allografts between January 2007 and January 2019. Forty-three patients were followed up. There were 19 Paprosky type IIIA bone defect patients and 24 Paprosky type IIIB bone defect patients and 7 patients of the 24 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included cage stability, allografts incorporation, and center of rotation.All patients were followed up with a mean follow-up of 10.6 years, HHS and SF-12 improved significantly at last follow-up in comparison to the preoperative. There were 2 re-revisions, one at 5 years after surgery, another at 13.6 years after surgery. Two patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface. Allografts of 40 (93%) cases incorporated fully.The combination of cage and morselized allograft is an alternative option for acetabular revision with Paprosky type III bone defects with satisfactory long-term follow-up results.
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Micheler, Carina M., Jan J. Lang, Nikolas J. Wilhelm, et al. "Scaling Methods of the Pelvis without Distortion for the Analysis of Bone Defects." Current Directions in Biomedical Engineering 8, no. 2 (2022): 797–800. http://dx.doi.org/10.1515/cdbme-2022-1203.
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Abstract For the development of new types of hip implants for acetabulum revision, it is beneficial to analyse the acetabular defects of the indication group in advance. In order to be able to specially compare the bone defects with each other, a normalisation and accompanying scaling of the pelvis is necessary. Uniform scaling is required so that the bone structures are not distorted. In the following study, three scaling methods based on the minimal bounding box and sphere principle are compared with a method using 14 landmarks on the pelvis.The landmark method is applied to determine the true scaling factor. For the comparison of the different methods, 40 female pelvic models with an acetabular defect are analysed. In the comparison of the scaling methods, the method using minimal bounding spheres shows the least deviation from the landmark method (mean difference 3.30 ± 2.17 %). Due to the fact that no preprocessing (definition of the landmarks) is required and the fast implementation of the algorithm, the minimal bounding sphere is to be preferred to the landmark method for a fast size estimation.
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Higuera, C. A., J. M. Villa, K. Rajschmir, P. Grieco, J. Manrique-Succar, and A. M. Riesgo. "A NOVEL HIP RECONSTRUCTION IN SITU WITH SCREWS AND CEMENT (HiRISC) CONSTRUCT TO TREAT LARGE ACETABULAR BONE DEFECTS: A PRELIMINARY REPORT." Orthopaedic Proceedings 105-B, SUPP_12 (2023): 5. http://dx.doi.org/10.1302/1358-992x.2023.12.005.
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Osteolysis, fractures, and bone destruction caused by osteomyelitis or metastasis can cause large bone defects and present major challenges during acetabular reconstruction in total hip arthroplasty. We sought to evaluate the survivorship and radiographic outcomes of an acetabular reconstruction consisting of a polyethylene liner (semi-constrained) embedded in cement filling bone defect(s) reinforced with screws and/or plates for enhanced fixation (HiRISC).Retrospective chart review of 59 consecutive acetabular reconstructions as described above performed by 4 surgeons in a single institution (10/18/2018-1/5/2023) was performed. After radiographs and operative reports were reviewed, cases were classified following the Paprosky classification for acetabular defects. Paprosky type 1 cases (n=26) were excluded, while types 2/3 (n=33) were included for analysis. Radiographic loosening was evaluated up to latest follow-up. Mean follow-up was: 487 days (range, 20–1,539 days).Out of 33 cases, 2 (6.1%) cases were oncological (metastatic disease) and 22 (66.7%) had deep infection diagnosis (i.e., periprosthetic joint infection [PJI] or septic arthritis). In total, 7 (21.2%) reconstructions were performed on native acetabula (3 septic, 4 aseptic). At a mean follow-up of 1.3 years, 5 (15.2%) constructs were revised: 4 due to uncontrolled infection (spacer exchange) and 1 for instability. On follow-up radiographs, only 1 non-revised construct showed increased radiolucencies, but no obvious loosening. When compared to patients with non-revised constructs, those who underwent revision (n=5) were significantly younger (mean 73.8 vs. 60.6 years, p=0.040) and had higher body mass index (24.1 vs. 31.0 Kg/m2, p=0.045), respectively. Sex, race, ethnicity, American-Society-of-Anesthesiologist classification, infection diagnosis status (septic/aseptic), and mean follow-up (449.3 vs. 695.6 days, respectively, p=0.189) were not significantly different between both groups.HiRISC construct may be a viable short-term alternative to more expensive implants to treat large acetabular defects, particularly in the setting of PJI. Longer follow up is needed to establish long term survivorship.
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Dinache, George, George M. Avram, Alexandru Hantascu, Radu Paraschiv, and Leonardo Tillieci. "3D reconstruction protocol in complex acetabular defects." Romanian Journal of Military Medicine 125, no. 1 (2022): 152–56. http://dx.doi.org/10.55453/rjmm.2022.125.1.21.
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The current paper describes the protocol used in our clinic for 3D imaging, reconstruction and printing of complex acetabular defects that are used for surgical planning of complex acetabular defects. Surgical guides have also been developed to aid optimal acetabular reamer placement in order to recreate the optimal hip rotation centre for each patient undergoing revision hip arthroplasty that has impaired acetabular bone stock
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Garcia-Rey, Eduardo, Laura Saldaña, and Eduardo Garcia-Cimbrelo. "Impaction bone grafting in hip re-revision surgery." Bone & Joint Journal 103-B, no. 3 (2021): 492–99. http://dx.doi.org/10.1302/0301-620x.103b3.bjj-2020-1228.r1.
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Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.
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Callary, S., J. Barends, L. B. Solomon, R. Nelissen, D. Broekhuis, and B. Kaptein. "VIRTUAL BIOMECHANICAL ASSESSMENT OF CUSTOM TRIFLANGE AND TRABECULAR METAL COMPONENTS TO TREAT LARGE ACETABULAR DEFECTS." Orthopaedic Proceedings 105-B, SUPP_12 (2023): 6. http://dx.doi.org/10.1302/1358-992x.2023.12.006.
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The best treatment method of large acetabular bone defects at revision THR remains controversial. Some of the factors that need consideration are the amount of residual pelvic bone removed during revision; the contact area between the residual pelvic bone and the new implant; and the influence of the new acetabular construct on the centre of rotation of the hip. The purpose of this study was to compare these variables in two of the most used surgical techniques used to reconstruct severe acetabular defects: the trabecular metal acetabular revision system (TMARS) and a custom triflanged acetabular component (CTAC).Pre- and post-operative CT-scans were acquired from 11 patients who underwent revision THR with a TMARS construct for a Paprosky IIIB defect, 10 with pelvic discontinuity, at Royal Adelaide Hospital. The CT scans were used to generate computer models to virtually compare the TMARS and CTAC constructs using a semi-automated method. The TMARS construct model was calculated using postoperative CT scans while the CTAC constructs using the preoperative CT scans. The bone contact, centre of rotation, inclination, anteversion and reamed bone differences were calculated for both models.There was a significant difference in the mean amount of bone reamed for the TMARS reconstructions (15,997 mm3) compared to the CTAC reconstructions (2292 mm3, p>0.01). There was no significant difference between overall implant bone contact (TMARS 5760mm2 vs CTAC 5447mm2, p=0.63). However, there was a significant difference for both cancellous (TMARS 4966mm2 vs CTAC 2887mm2, p=0.008) and cortical bone contact (TMARS 795mm2 vs CTAC 2560mm2, p=0.001). There was no difference in inclination and anteversion achieved. TMARS constructs resulted on average in a centre of rotations 7.4mm more lateral and 4.0mm more posterior.Modelling of two different reconstructions of Paprosky IIIB defects demonstrated potential important differences between all variables investigated.
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Sadovoy, M. A., V. V. Pavlov, V. A. Bazlov, et al. "POTENTIALITIES OF 3D-VISUALIZATION IN PREOPERATIVE PLANNING OF PRIMARY AND REVISION TOTAL HIP ARTHROPLASTY." Vestnik travmatologii i ortopedii imeni N.N. Priorova, no. 3 (September 30, 2017): 37–42. http://dx.doi.org/10.32414/0869-8678-2017-3-37-42.
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A variant of preoperative planning for revision interventions on a hip joint named “Method of layer by layer 3D visualization of the defect zone” is suggested. The method is realized via three consecutive steps with the ultimate aim to obtain data on the real acetabular defect geometry and bone tissue density. Using that method 9 patients (mean age 60±2 years) with pelvic bones defects were examined preoperatively. Based on the evaluation results of bone tissue condition in the defect zone the model and size of individual augment within the limits of weight bearing bone were corrected, the points of augment and acetabular component fixation were determined.
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Sadovoy, M. A., Vitaliy V. Pavlov, V. A. Bazlov, et al. "Potentialities of 3D-Visualization in Preoperative Planning of Primary and Revision Total Hip Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 24, no. 3 (2017): 37–42. http://dx.doi.org/10.17816/vto201724337-42.
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A variant of preoperative planning for revision interventions on a hip joint named “Method of layer by layer 3D visualization of the defect zone” is suggested. The method is realized via three consecutive steps with the ultimate aim to obtain data on the real acetabular defect geometry and bone tissue density. Using that method 9 patients (mean age 60±2 years) with pelvic bones defects were examined preoperatively. Based on the evaluation results of bone tissue condition in the defect zone the model and size of individual augment within the limits of weight bearing bone were corrected, the points of augment and acetabular component fixation were determined.
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Wu, X.-D., W. Xu, M. Tian, Q. Cheng, and W. Huang. "Cup-on-cup technique to manage severe protrusio acetabular defects." Annals of The Royal College of Surgeons of England 100, no. 7 (2018): e181-e184. http://dx.doi.org/10.1308/rcsann.2018.0112.
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Previous studies have demonstrated that revision of total hip arthroplasty consumes considerably more resources than the primary procedure. Worse, patients who need revision procedures are more likely to have radiographic evidence of acetabular and femoral bone loss than those undergone primary total hip arthroplasty. Many techniques have been introduced to manage different conditions of acetabular deficiencies. We describe a rare case of a 67-year-old man with severe acetabular bone loss, which was caused by a long-term loose acetabular component and was successfully managed by cup-on-cup technique. We also discuss the similarities and differences between cup-on-cup and cup-in-cup techniques in the management of protrusio acetabular defects, with a case-based approach.
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Cano, Jaime J. Morales De, Llorenç Guillamet, and Arturo Perez Pons. "ACETABULAR RECONSTRUCTION IN PAPROSKY TYPE III DEFECTS." Acta Ortopédica Brasileira 27, no. 1 (2019): 59–63. http://dx.doi.org/10.1590/1413-785220192701187313.
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ABSTRACT Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head. Level of Evidence IV, Case Series.
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Aleksanyan, Hovakim A., Hamlet A. Chragyan, Sergey V. Kagramanov, Artem V. Ivanov, Konstantin Yu Ukolov, and Egor V. Polevoy. "Early results of revision acetabular endoprosthetics using individual designs." N.N. Priorov Journal of Traumatology and Orthopedics 29, no. 4 (2023): 355–65. http://dx.doi.org/10.17816/vto170996.
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BACKGROUND: 3D-printed implants are one of the options for acetabulum reconstruction. The popularity of this technique is increasing every year.
 AIM: To evaluate the early clinical, radiological and functional results of revision arthroplasty using individual acetabular components in patients with acetabulum bone defects.
 MATERIALS AND METHODS: Revision endoprosthetics was performed in 50 patients. There were 36 female and 14 male patients. The patients mean age was 60.413.4 (2389) years. According to the Paprosky classification, the defects in 1 case corresponded to type IIC, in 12 cases to type IIIA, in 37 cases to type IIIB, including 8 cases with violation of the acetabulum integrity. Hip joint function was assessed using the Harris Hip Score (HHS), pain severity using the Visual Analogue Scale (VAS), and social adjustment using the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
 RESULTS: Significant improvement was obtained on all assessment scales. The HHS score improved on average from 33.6 to 87.1 points, the VAS scale from 78.1 to 4.7 points, and the WOMAC from 75.8 to 11.6 points. There were 8 cases (21%) with complications in total. In one case with a violation of the acetabulum integrity we observed migration of the sciatic bone from the lower flange of the construct.
 CONCLUSION: Thus, the results of the acetabulum reconstruction using individually fabricated acetabular components are promising.
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Pandey, Arun Kumar. "Midterm Results Of Flanged Acetabular Cup Used In Severe Acetabular Defects." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (2020): 2325967120S0011. http://dx.doi.org/10.1177/2325967120s00113.
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Background: Revision hip arthroplasty complicated by massive acetabular defects and/or pelvic discontinuity has remained difficult to manage, with no definite option to produce predictable results. Acetabular cages and reinforcement rings have high failure rates because of lack of biological fixation. Custom triflange cups are economically demanding like cup-cage constructs, and require time to be fabricated. Cementless acetabular cup having an ischial hook and three iliac flanges is a technically simple but effective option to be used in such situations. Questions/purposes: We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on HSS and WOMACscores; (3) radiological outcomes based primarily on component migration; (5) mean operative time and (4) the complication rate for a series of 18 procedures. Methods: We conducted a retrospective review of all the revision hip arthroplasty procedures performed between January 2013 and May 2015 and identified 18 procedures in 18 patients where a cementless porous-coated hemispherical cup (Combicup-R, Link) was used. According to AAOS classification, 8 of the 18 (44%) acetabuli had Type 3 defect and 10 of 18 (56%) acetabuli had Type 4 defect. Structural bone allografts were used in 7 cases and all cases required morsellized allograft. The minimum followup was of 49 months and average was of 58 months (range, 49–67 months; SD, 34.3). Postoperative clinical evaluation was done at 6 weeks, 3, 6, and 12 months, and annually thereafter. HSS and WOMAC scores were recorded at follow up and radiographs were taken. Serial radiographs were compared with the 6-week postoperative radiographs to evaluate for component loosening/migration and structural graft resorption. Results: The 6-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1–97.4). HSS and WOMAC score improved significantly from a preoperative value of 54 and 43 respectively to 87 and 85 postoperatively (p < 0.001). One patient had resorption of structural allograft and subsequent cup migration, which needed re- revision surgery. Conclusions: Porous coated acetabular cup supplemented with flanges and hooks is a suitable option to treat severe acetabular defects and pelvic discontinuity in acetabular revision reconstructions, than cages which do not provide biological fixation. Compared to custom triflange cups, they are more economical, technically easier to implant and do not require any waiting period to be fabricated.
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Du, Yinqiao, Jun Fu, Jingyang Sun, et al. "Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study." BioMed Research International 2020 (August 25, 2020): 1–12. http://dx.doi.org/10.1155/2020/4809013.
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Background. The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect in Crowe type II or III developmental dysplasia of the hip (DDH), which could evaluate the stability of the acetabular cup with different types of bone defects, different diameters of femoral ceramic heads, and the use of screws and analyze the stress distribution of screws. Methods. The FEA model was based on the CT scan of a female patient without any acetabular bone defect. The model of acetabular bone defect in total hip arthroplasty for Crowe II or III DDH was made by the increasing superolateral bone defect area of the acetabular cup. Point A was located in the most medial part of the acetabular bone defect. A 52 mm PINNACLE cup with POROCOAT Porous coating was implanted, and two screws (the lengths were 25 mm and 40 mm) were implanted to fix the acetabular cup. The stability of the acetabular cup and the von Mises stress of point A and screws were analyzed by a single-legged stance loading applied in 1948 N (normal working). The different diameters of the femoral ceramic head (28 mm, 32 mm, and 36 mm) were also analyzed. Results. The von Mises stress of point A was gradually increased with the increasing uncoverage values. When the uncoverage values exceeded 24.5%, the von Mises stress of point A without screws increased significantly, leading to instability of the cup. Screws could effectively reduce the von Mises stress of point A with uncoverage values of more than 24.5%. However, the peak von Mises stress in the screws with the uncoverage values that exceeded 24.5% was considerably increased. The diameter of the femoral ceramic head had no significant effect on the von Mises stress and the stability of the acetabular cup. Conclusions. We recommend that uncoverage values of less than 24.5% with or without screw is safe for patients with Crowe II or III DDH.
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Arts, J. J. C., J. W. M. Gardeniers, M. L. M. Welten, N. Verdonschot, B. W. Schreurs, and P. Buma. "TCP-HA Granules and Impacted Morselized Cancellous Bone Graft Mixes for Acetabular Reconstruction with the Bone Impaction Grafting Technique. A Loaded and Critical Sized Defect Model in the Goat." Key Engineering Materials 284-286 (April 2005): 869–72. http://dx.doi.org/10.4028/www.scientific.net/kem.284-286.869.
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With the bone impaction grafting technique, a 50/50 volume mix of morselized cancellous bone (MCB) with TCP-HA granules was used to reconstruct a critical sized acetabular defect in the goat. The biological activity of the MCB/TCP-HA mix was assessed after 15 weeks. Defects filled with 100% MCB, currently the gold standard for this technique, were used as controls. In the 100% MCB defects, a new trabecular bone structure was found in which scarce incorporated remnants of the original graft material were present. In the MCB/TCP-HA defects, MCB was also resorbed or incorporated into new bone. Deep in the MCB-TCP-HA defects, large TCP-HA granules were generally totally osseous-integrated with new bone. Superficially, more fragmented TCP-HA granules of various sizes were present in the medullar tissue or in the interface with the cement layer. Here, the crushed TCP-HA granules were generally surrounded by osteoclasts and giant cells. The soft tissue interface between the reconstruction and cement did not differ between both groups. In conclusion, from a biological point of view, this short-term follow-up study suggests that TCP-HA granules can be safely used in a mix with MCB as bone graft extender in acetabular revision surgery with the bone impaction grafting technique.
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Soetanto, Rendy Cahya, Muhammad Naseh Budi, and Darmadji Ismono. "Reconstruction of Acetabular Wall Using Autologous Bone Graft Following Resection of Pelvic Chondrosarcoma: Surgical Technique and Functional Outcome." Indonesian Journal of Cancer 13, no. 3 (2019): 91. http://dx.doi.org/10.33371/ijoc.v13i3.663.
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Background: Pelvic chondrosarcoma may be difficult to manage due to its proximities with vital structures. The study aimed to explain an alternative surgical technique for acetabular reconstruction.Case Presentation: We present a case of a 48-year-old female with large chondrosarcoma of the superior and inferior pubic rami with medial acetabular wall involvement. Pelvic type 3 resection was performed. There was a defect at medial acetabulum after resection. The defect was covered by autograft from iliac and fixation using screws. Rotational pelvic stability was maintained using a reconstruction plate. The functional outcome was assessed 6 months after operation using MSTS and the score was 30, which was painless, full weight bearing, normal gait, and no pain. Conclusions: Reconstruction of the pelvis after tumor resection requires a careful preoperative patient evaluation and extensive bone and soft tissue resection to achieve negative tumor margins and stable reconstruction of the osseous and soft tissue defects.
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Tsybin, A. V., V. V. Lyubchak, A. S. Falkovich, S. S. Bilyk, and V. A. Shilnikov. "Determining congruence of the standard hemispherical acetabular component and post‑traumatic acetabulum in primary total hip arthroplasty (experimental study)." Genij Ortopedii 28, no. 5 (2022): 698–703. http://dx.doi.org/10.18019/1028-4427-2022-28-5-698-703.
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Introduction An original ASPID classification was developed for primary total hip arthroplasty in the presence of post-traumatic acetabular deformity at the Vreden National Medical Research Centre for Traumatology and Orthopaedics. We aimed to explore how the extent of displacement and localization of acetabular deformity as classified by the original ASPID grading system can affect the coverage area of the acetabular component. The purpose of the study was to determine the congruence of the standard hemispherical acetabular component and the post-traumatic acetabular deformity in the experiment. Material and methods Computer 3D models of 92 post-traumatic acetabulums were formed, followed by simulated implantation of a standard hemisphere of the appropriate size in compliance with permissible values of the spatial orientation of the acetabular cup in total hip replacement. The congruence of the deformed acetabulum and the standard hemisphere of the corresponding size was determined with simulated implantation. Formula for the acetabular deformity was determined for each case using the original classification. With formula identified for each acetabular deformity and the magnitude of congruence, the data were compared to determine the relationship between congruence, bone displacement and the extent of bone displacement. Results The mean congruence value in the group was 59.5 ± 16.83 %. The sum of the scores A+S+P+I+D was compared with the percentage of congruence. The statistical analysis showed that the congruence of the hemispherical acetabular component and the post-traumatic acetabulum was less than 70% with a sum of parameters greater than four. The continuation of the study will allow for a more global analysis and identification of more patterns to improve surgical approaches to primary total hip arthroplasty in specific cases. Conclusion Screws can be recommended for reliable primary mechanical fixation of the pelvic component in target patients, and cavitary bone defects can be repaired with autobone chips to allow greater congruence at the bone-implant interface.
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Bolognesi, Michael P., Jason M. Jennings, and Daniel J. Scott. "Novel Use of a Trabecular Metal Augment in a Severe Acetabular Defect." Duke Orthopaedic Journal 7, no. 1 (2017): 39–42. http://dx.doi.org/10.5005/jp-journals-10017-1080.
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ABSTRACT Many total hip arthroplasties are complicated by severe acetabular bone loss, limiting reconstruction options. This case report details the use of a 54-mm trabecular metal straight buttress and press-fit jumbo cup to reconstruct an especially large superior and medial defect (Paprosky type IIIB). Specifically, the large defect was reconstructed by placing the augment superior-medially in the acetabular defect instead of simply superiorly and attached to the iliac wing as it is more commonly employed. To our knowledge, there has been no reported use of a similar augment to fill such a defect in this way. This technique represents a promising potential option for reconstruction of especially large superior and medial acetabular defects Scott DJ, Jennings JM, Bolognesi MP. Novel Use of a Trabecular Metal Augment in a Severe Acetabular Defect. The Duke Orthop J 2017;7(1):39-42.
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Zagorodniy, N. V., V. I. Nuzhdin, I. A. Nikolaev, S. V. Kagramanov, and V. S. Komlev. "Osteoplastic Substitution of Acetabular Defects at Revision Hip Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 20, no. 4 (2013): 29–33. http://dx.doi.org/10.17816/vto20130429-33.
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First experience in application of synthetic and natural osteoconductive biocompatible materials of calcium orthophosphates that gradually resorb and are substituted by newly formed bone tissue is presented. Those osteoplastic materials were used in 11 patients aged 45–78 years at revision hip arthroplasty due to unstable acetabular component. According to W. Paprosky classification II A type of acetabular defect was diagnosed in 2 patients, II B type — in 2, II C type — in 3, III A type — in 3 and type III B — in 1 patient. Volume of used material was determined by the size of bone defect and ranged from 10 to 50 g. At terms from 3 to 18 months satisfactory treatment result was observed in all patients. Control X-rays and computed tomograms showed that structure of remodeled bone tissue approximated to the acetabular structure and its’ density almost corresponded to pelvic bones density.
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Dinache, George, Marinel Drignei, Stergios Ganatsios, et al. "Theoretical Aspects, Modern Treatment Options and Practical Case Presentations in Hip and Knee Tumoral and Revision Bone Defect Reconstruction Surgery." Revista de Chimie 69, no. 12 (2019): 3664–68. http://dx.doi.org/10.37358/rc.18.12.6815.
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Bone defects are a challenge to any and in fact every orthopedic surgeon, be they as a consequence of trauma, peri-implant bone loss as is the case in revision surgery or, more often than not, in tumors of the bone. These defects are in most cases difficult to reconstruct, but even more so in the case when they are located around the major joints of the lower limb, i.e. the hip and the knee. We focus in this article on acetabular bone defects as well as on defects around the knee (distal femur and proximal tibia). We present implant possibilities and modern means of reconstructing the bone defect using augments. We also present three representative cases from our Clinic, to further exemplify the discussed concepts. We present our opinions on reconstructing bone defects after tumor and revision surgery in the hip and knee and we draw conclusions.
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El Axir, Husam M., Mohamed G. Alashhab, and Karim S. Khater. "Trabecular Metal Augments for Reconstruction of Acetabular Bone Defects in Revision Total Hip Replacement: Short-Term Outcomes." Journal of Arthroscopy and Joint Surgery 11, no. 3 (2024): 108–13. http://dx.doi.org/10.4103/jajs.jajs_90_23.
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Abstract Background: Revision hip surgeries are increasing dramatically nowadays, and achieving hip center of rotation is challenging. Obtaining a press-fit implant and restoring the hip’s center of rotation might be difficult during the restoration of acetabular deformities during revision total hip arthroplasty (THA). Aim: The aim of the study was to evaluate the outcomes of using trabecular metal augments for reconstruction of the acetabulum in patients undergoing revision THA with short-term follow-up. Patients and Methods: This study was conducted in Benha University Hospital between April 2019 and March 2023. It is a prospective cohort study including 20 patients who are undergoing revision THA with acetabular defects. Results: The mean age of patients in this study was 59 years old. According to Paprosky classification: 45% of type 2B. The postoperative Oxford Hip Score showed marked improvement in the outcomes, the score was excellent in 55% (11 patients), good in 40% (8 patients), and fair in only 5% (1 patient) over 16 months’ mean follow-up period. Conclusion: Due to its modularity, tantalum augments are considered a valuable method in the reconstruction of acetabular defects.
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Mogos, Stefan, George Viscopoleanu, Monica Dascalu, and Radu Orfanu. "Reconstruction of Severe Acetabular Bone Defects in Revision Hip Arthroplasty Management options and clinical outcomes." Revista de Chimie 69, no. 8 (2018): 2217–21. http://dx.doi.org/10.37358/rc.18.8.6503.
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The objective of this study was to evaluate the effectiveness of different surgical implants for the reconstruction of severe acetabular bone defects in revision arthroplasty of the hip. The current study is a retrospective study on 32 patients with Paprosky type IIIA or IIIB acetabular defects operated between January 2012-December 2015 in a single hospital. The mean follow-up was 21 months (12-43 months). Five different types of reconstruction methods were used: primary uncemented cups with or without screws, cemented acetabular cups, tantalum cups, metal augments and antiprotrusio cages. Bone allograft was available in all cases. Functional outcome after surgery was evaluated using Harris Hip Score. Based on Paprosky classification, the study included 16 type IIIA and 16 type IIIB acetabular defects. Bone graft was used in 71.8% of the cases (23 out of 32 patients). Tantalum cups were used in 15 cases (46.9%), being the preferred implant. Primary uncemented cups were used in 2 cases, cemented acetabular cups were used in 4 cases, trabecular metal augments were used in 5 cases and antiprotrusion cages were used in 6 cases. The mean Harris Hip Score improved from 37.3�7.4 pre-operatively to 82.1�7.2 at final follow-up. In conclusion, the current study demonstrates that various methods of reconstruction are efficient in the short and medium-term.
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Cursaru, Adrian, Bogdan Şerban, Alexandru George Lupu, et al. "Using Tantalum Augments for Major Acetabular Bone Defects in Revision Hip Surgery." Romanian Journal of Orthopaedic Surgery and Traumatology 2, no. 2 (2019): 64–68. http://dx.doi.org/10.2478/rojost-2019-0014.
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AbstractAim. The purpose of the study was to follow up the clinical and functional results of the patients with major acetabular bone defects in revision hip surgery.Materials and methods. The study was retrospective, over a period of six years (from January 2014 to January 2019), and included all the patients with hip replacement, with major acetabular bone defects, who needed Tantalum blocks substitution.11 patients were included in the study (8 men and 3 women). The average age was 71 years (between 64 and 78 years old). The average follow up period was 23 months (between 11 and 36 months). Paprosky radiological classification was used for the preoperatory evaluation of the bone defects. In 9 cases, the bone defect was of type 2B Paprosky and in 2 cases, of type 3A. Harris score was determined preoperatory and postoperatory for the appreciation of functional results.Results. 6 patients were underwent replacement for coxarthrosis secondary to dysplasia, 2 patients for coxarthrosis secondary to aseptic necrosis and 3 patients for primary coxarthrosis.The average time elapsed from the moment of primary arthroplasty to the need of revision surgery was on average of 13 years (between 7 and 16 years). The postoperatory radiological evaluation showed an improvement of the hip rotation center from an average postoperative vertical position of 3.1 cm (between 1.2 and 4.6 cm) at an average postoperatory position of 1.1 cm (between 0.5 and 2.3). The average result of Harris score postoperatively was 36 (between 39 and 96). During the follow up period, no early loosening, infection or prosthesis dislocation was registered. Conclusions. The Tantalum Augments used in major acetabular bone defects in revision surgery represent a good option, correcting the hip rotation center, thus considerably improving the functional score.
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Ciriviri, Jasmin, Zoran Nestorovski, Darko Talevski, Tode Vranishkovski, and Hristijan Kostov. "Treatment of Acetabular Defects with Porous Metal Augments in Revision Hip Surgery." PRILOZI 40, no. 2 (2019): 33–39. http://dx.doi.org/10.2478/prilozi-2019-0012.
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Abstract Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.
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Fröschen, Frank Sebastian, Thomas Martin Randau, El-Mustapha Haddouti, et al. "Establishment of a Periprosthetic Acetabular Bone Defect in an In Vivo Model." Applied Sciences 14, no. 8 (2024): 3375. http://dx.doi.org/10.3390/app14083375.
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The biological reconstruction of periprosthetic acetabular defects is essential for the success of revision total hip arthroplasty. However, a standardized in vivo defect model with good analogy to the human situation is still lacking, which has significantly limited the research and development of this highly important clinical entity. A defined animal defect model might be a possible solution as it offers the possibility to evaluate different biomaterials for periacetabular bone reconstruction in a reproducible setting. In an ovine periacetabular defect model (n = 27), a defined bone defect (1.5 × 1.5 × 1.5 cm/3.375 cm3) in the cranial load-bearing area of the acetabulum was augmented with two different biomaterials as well as autologous cancellous bone in an ovine periprosthetic defect model and bridged with a Ganz reinforcement ring (n = 9 animals per group). Eight months after implantation, radiological and macroscopic examination was performed. The operation with the establishment of a defined periacetabular defect could be performed in all cases. There were no intraoperative complications in the three groups. During the course of the experiment, three sheep had to be excluded due to complications. A macroscopic evaluation after 8 months showed a firm neocapsula surrounding the hip joint with macroscopic consolidation of the bony defect and a stable inlying implant. There were no detectable differences between the three groups in the macroscopic or radiological evaluation. In summary, the presented ovine model might offer the possibility to create a defined bone defect and investigate bone defect reconstruction with different materials.
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Gibon, E., N. Barut, J.-P. Courpied, and M. Hamadouche. "Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum." Bone & Joint Journal 100-B, no. 6 (2018): 725–32. http://dx.doi.org/10.1302/0301-620x.100b6.bjj-2017-1472.r1.
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Aims The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d’Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725–32.
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Hwang, Kyu Tae, and Young Ho Kim. "Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects." Journal of the Korean Hip Society 23, no. 4 (2011): 237. http://dx.doi.org/10.5371/jkhs.2011.23.4.237.
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Hettich, Georg, Ronja A. Schierjott, Heiko Ramm, et al. "Method for quantitative assessment of acetabular bone defects." Journal of Orthopaedic Research 37, no. 1 (2018): 181–89. http://dx.doi.org/10.1002/jor.24165.
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Bazlov, V. A., T. Z. Mamuladze, O. I. Golenkov, et al. "Effects of 3D Imaging on Surgical Tactics in Primary and Revision Hip Arthroplasty." Traumatology and Orthopedics of Russia 26, no. 2 (2020): 60–70. http://dx.doi.org/10.21823/2311-2905-2020-26-2-60-70.
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3D imaging tools significantly expand the ability to assess the bone tissue condition, both in terms of its qualitative properties and in terms of accurate determination of bone defect geometry and volume.The purpose of the study was to determine the 3D imaging potential for the preoperative planning and correction of surgical tactics in hip arthroplasty.Materials and Methods. A retrospective analysis of the preoperative planning of 110 primary and revision hip arthroplasties with 3D imaging was performed. The following specialized software were employed: RadiAnt DICOM Viewer file converter — for 3D models production; 3D/CAD designers — for volumetric models processing and correction; InVesalius 3.0 program — for bone density evaluation by the Hounsfield scale; K-Pacs — for viewing MSCT and X-ray images. All patients underwent pelvic bones radiography in the front and anterior-lateral planes. Post-traumatic acetabular deformity was described in accordance with the X-ray picture in each individual clinical case. For revision arthroplasty, the acetabular defect was determined according to the W.G. Paprosky classification. In 36 patients (32.7%), the acetabulum defect was the result of trauma. In 74 patients (67.3%), the cause of surgery was endoprosthesis components loosening.Results. In 80% of cases (88 patients), the analysis of the 3D model did not change the surgical tactics determined in the preoperative planning using pelvic radiographs; in 20% of cases (22 patients), the use of 3D imaging revealed new circumstances and changed the surgical tactics.Conclusion. In standard cases, it is possible to use the traditional preoperative planning using radiographs in several planes. In primary hip arthroplasty in the patients with post-traumatic deformity, including a false joint of acetabulum bottom or 2 to 3 degree osteopenia, it is advisable to perform 3D imaging. In the case of revision arthroplasty, 3D visualization is indicated in acetabulum Paprosky IIIA, IIIB defects with pelvic discontinuity.
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Loppini, Mattia, Paolo Schiavi, Antonello Della Rocca, et al. "Double-trabecular metal cup technique for the management of Paprosky type III defects without pelvic discontinuity." HIP International 28, no. 2_suppl (2018): 66–72. http://dx.doi.org/10.1177/1120700018813208.
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Introduction: Modular reconstruction systems based on trabecular metal (TM) prosthetic components have been increasingly used in the last decade for the management of severe acetabular bone defects. The aim of this study was to assess the clinical and radiographic outcomes of double-cup technique for the management of Paprosky type III defects without pelvic discontinuity. Methods: A retrospective review was performed for all patients undergoing acetabular reconstruction with 2 TM cups at a tertiary referral centre between 2010 and 2015. Harris Hip Scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at the latest follow-up. Radiographic assessment of the hip centre of rotation (COR) position and leg length discrepancy (LLD) was performed preoperatively and postoperatively. Osteolysis and radiolucencies, loosening of the implants, and heterotopic ossifications were evaluated with the latest follow-up radiographs. Results: Patients included 5 men and 11 women (16 hips) with an average age of 68 (45–81) years. Acetabular bone defects included 9 Paprosky type IIIB and 7 type IIIA defects. No pelvic discontinuities were registered. The mean follow-up was 34 (24–72) months. HHS and WOMAC scores, LLD and COR position significantly improved after surgery. In only 1 (6.3%) hip a not progressive radiolucent line adjacent the acetabular construct was noted. Heterotopic ossifications were found in 2 (12.5%) hips. No patients underwent acetabular components revision surgery for any reason. Conclusion: The double-cup technique could be considered an effective management of selected Paprosky type III defects without pelvic discontinuity providing excellent clinical and radiographic outcomes in the short term.
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Löchel, J., V. Janz, C. Hipfl, C. Perka, and G. I. Wassilew. "Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up." Bone & Joint Journal 101-B, no. 3 (2019): 311–16. http://dx.doi.org/10.1302/0301-620x.101b3.bjj-2018-0959.r1.
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Aims The use of trabecular metal (TM) shells supported by augments has provided good mid-term results after revision total hip arthroplasty (THA) in patients with a bony defect of the acetabulum. The aim of this study was to assess the long-term implant survivorship and radiological and clinical outcomes after acetabular revision using this technique. Patients and Methods Between 2006 and 2010, 60 patients (62 hips) underwent acetabular revision using a combination of a TM shell and augment. A total of 51 patients (53 hips) had complete follow-up at a minimum of seven years and were included in the study. Of these patients, 15 were men (29.4%) and 36 were women (70.6%). Their mean age at the time of revision THA was 64.6 years (28 to 85). Three patients (5.2%) had a Paprosky IIA defect, 13 (24.5%) had a type IIB defect, six (11.3%) had a type IIC defect, 22 (41.5%) had a type IIIA defect, and nine (17%) had a type IIIB defect. Five patients (9.4%) also had pelvic discontinuity. Results The overall survival of the acetabular component at a mean of ten years postoperatively was 92.5%. Three hips (5.6%) required further revision due to aseptic loosening, and one (1.9%) required revision for infection. Three hips with aseptic loosening failed, due to insufficient screw fixation of the shell in two and pelvic discontinuity in one. The mean Harris Hip Score improved significantly from 55 (35 to 68) preoperatively to 81 points (68 to 99) at the latest follow-up (p < 0.001). Conclusion The reconstruction of acetabular defects with TM shells and augments showed excellent long-term results. Supplementary screw fixation of the shell should be performed in every patient. Alternative techniques should be considered to address pelvic disconinuity. Cite this article: Bone Joint J 2019;101-B:311–316.
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Ertürk, Cemil, Simel Ayyıldız, and Cevdet Erdöl. "Orthopedics and 3D technology in Turkey: A preliminary report." Joint Diseases and Related Surgery 32, no. 2 (2021): 279–89. http://dx.doi.org/10.52312/jdrs.2021.20.
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Objectives: In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery. Materials and methods: Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA). Results: More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery. Conclusion: Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.