Skip to main content
Erschienen in: International Orthopaedics 8/2016

07.11.2015 | Original Paper

Acetabular reconstruction with a reinforcement device and bone grafting in revision arthroplasty—a mean five years of follow-up

verfasst von: Ancuța Zazgyva, Sándor-György Zuh, Ciprian Oliviu Roman, István Gergely, Tudor Sorin Pop

Erschienen in: International Orthopaedics | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the clinical and radiological outcomes of acetabular reconstruction using a reinforcement device (RD) in combination with bone grafting in Paprosky type 2 and 3 acetabular bone defects.

Methods

Morselised bone grafts were used to fill cavitary defects and a structural graft placed in the superior part of the acetabulum in cases of cranial bone defects, with a proximally fixed RD (Protetim, Hódmezővásárhely, Hungary) implanted in all cases. Construct stability, device positioning, hip centre of rotation and medial acetabular wall thickness were evaluated radiologically. Survival rates were estimated with aseptic loosening and revision for any reason as endpoints.

Results

The 28 patients (29 hips) were followed for 4.8 ± 2.7 years (range, 2-10.4 years). Hip centre of rotation was lowered in all cases, with no significant differences between the mean values obtained post-operatively and at the last follow-up. Medial acetabular wall thickness and RD abduction angle were maintained up to the last evaluation. Bone grafts integrated by two years post-operatively in the majority of cases. Kaplan-Meier survival rates were 85.2 % and 82.1 % for the two endpoints at ten years.

Conclusions

Acetabular reconstruction using a proximally fixed RD in combination with bone grafting offered good mid-term results in the treatment of acetabular bone defects. In cases of severe bone loss, the structural allograft allowed placement of the RD with ischial contact, rendering survival rates similar to RDs with both iliac and ilioischial fixation. The technique was successful in restoring and maintaining medial acetabular bone stock and construct stability for up to ten years.
Literatur
2.
Zurück zum Zitat Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32(5):597–604. doi:10.1007/s00264-007-0364-3 CrossRefPubMed Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32(5):597–604. doi:10.​1007/​s00264-007-0364-3 CrossRefPubMed
5.
Zurück zum Zitat Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38(12):2455–2461. doi:10.1007/s00264-014-2443-6 CrossRefPubMed Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38(12):2455–2461. doi:10.​1007/​s00264-014-2443-6 CrossRefPubMed
6.
Zurück zum Zitat Inoue D, Kabata T, Maeda T, Kajino Y, Yamamoto T, Takagi T, Oomori T, Tsuchiya H (2015) The value of bulk femoral head allograft in acetabular reconstruction using Kerboull-type plate. Int Orthop 39(9):1839–1844. doi:10.1007/s00264-015-2857-9 CrossRefPubMed Inoue D, Kabata T, Maeda T, Kajino Y, Yamamoto T, Takagi T, Oomori T, Tsuchiya H (2015) The value of bulk femoral head allograft in acetabular reconstruction using Kerboull-type plate. Int Orthop 39(9):1839–1844. doi:10.​1007/​s00264-015-2857-9 CrossRefPubMed
7.
Zurück zum Zitat Abolghasemian M, Sadeghi Naini M, Tangsataporn S, Lee P, Backstein D, Safir O, Kuzyk P, Gross AE (2014) Reconstruction of massive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Joint J 96-B(3):319–324. doi:10.1302/0301-620X.96B3.32850 CrossRefPubMed Abolghasemian M, Sadeghi Naini M, Tangsataporn S, Lee P, Backstein D, Safir O, Kuzyk P, Gross AE (2014) Reconstruction of massive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Joint J 96-B(3):319–324. doi:10.​1302/​0301-620X.​96B3.​32850 CrossRefPubMed
8.
9.
Zurück zum Zitat Gross AE (2006) Restoration of acetabular bone loss 2005. J Arthroplasty 21(4 Suppl 1):117–120CrossRefPubMed Gross AE (2006) Restoration of acetabular bone loss 2005. J Arthroplasty 21(4 Suppl 1):117–120CrossRefPubMed
10.
Zurück zum Zitat Berry DJ (2004) Antiprotrusio cages for acetabular revision. Clin Orthop Relat Res 420:106–112CrossRefPubMed Berry DJ (2004) Antiprotrusio cages for acetabular revision. Clin Orthop Relat Res 420:106–112CrossRefPubMed
11.
12.
Zurück zum Zitat Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9(1):33–44CrossRefPubMed Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9(1):33–44CrossRefPubMed
13.
Zurück zum Zitat Gill TJ, Sledge JB, Muller ME (1998) The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg (Br) 80(6):946–953CrossRef Gill TJ, Sledge JB, Muller ME (1998) The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg (Br) 80(6):946–953CrossRef
14.
Zurück zum Zitat Pierchon F, Migaud H, Duquennoy A, Fontaine C (1993) Radiologic evaluation of the rotation center of the hip. Rev Chir Orthop Reparatrice Appar Mot 79(4):281–284PubMed Pierchon F, Migaud H, Duquennoy A, Fontaine C (1993) Radiologic evaluation of the rotation center of the hip. Rev Chir Orthop Reparatrice Appar Mot 79(4):281–284PubMed
15.
Zurück zum Zitat Pascarel X, Liquois F, Chauveaux D, Le Rebeller A, Honton JL (1993) The use of Muller acetabular rings in revision surgery of total hip prosthesis. Apropos of 141 cases with a minimal 5-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 79(5):357–364PubMed Pascarel X, Liquois F, Chauveaux D, Le Rebeller A, Honton JL (1993) The use of Muller acetabular rings in revision surgery of total hip prosthesis. Apropos of 141 cases with a minimal 5-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 79(5):357–364PubMed
16.
Zurück zum Zitat Bonnomet F, Clavert P, Gicquel P, Lefebvre Y, Kempf JF (2001) Reconstruction by graft and reinforcement device in severe aseptic acetabular loosening: 10 years survivorship analysis. Rev Chir Orthop Reparatrice Appar Mot 87(2):135–146PubMed Bonnomet F, Clavert P, Gicquel P, Lefebvre Y, Kempf JF (2001) Reconstruction by graft and reinforcement device in severe aseptic acetabular loosening: 10 years survivorship analysis. Rev Chir Orthop Reparatrice Appar Mot 87(2):135–146PubMed
17.
Zurück zum Zitat Massin P, Tanaka C, Huten D, Duparc J (1998) Treatment of aseptic acetabular loosening by reconstruction combining bone graft and Muller ring. Actuarial analysis over 11 years. Rev Chir Orthop Reparatrice Appar Mot 84(1):51–60PubMed Massin P, Tanaka C, Huten D, Duparc J (1998) Treatment of aseptic acetabular loosening by reconstruction combining bone graft and Muller ring. Actuarial analysis over 11 years. Rev Chir Orthop Reparatrice Appar Mot 84(1):51–60PubMed
18.
Zurück zum Zitat Philippe R, Gosselin O, Sedaghatian J, Dezaly C, Roche O, Sirveaux F, Mole D (2012) Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res 98(2):129–137. doi:10.1016/j.otsr.2011.11.003 CrossRefPubMed Philippe R, Gosselin O, Sedaghatian J, Dezaly C, Roche O, Sirveaux F, Mole D (2012) Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res 98(2):129–137. doi:10.​1016/​j.​otsr.​2011.​11.​003 CrossRefPubMed
19.
Zurück zum Zitat Kowalczewski JB, Rutkowska-Sak L, Marczak D, Slowinska I, Slowinski R, Sibinski M (2013) Bone graft incorporation after revision hip arthroplasty in patients with rheumatoid arthritis: seventy eight revisions using bone allografts with or without metal reinforcements. Int Orthop 37(4):595–598. doi:10.1007/s00264-013-1794-8 CrossRefPubMedPubMedCentral Kowalczewski JB, Rutkowska-Sak L, Marczak D, Slowinska I, Slowinski R, Sibinski M (2013) Bone graft incorporation after revision hip arthroplasty in patients with rheumatoid arthritis: seventy eight revisions using bone allografts with or without metal reinforcements. Int Orthop 37(4):595–598. doi:10.​1007/​s00264-013-1794-8 CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Kawanabe K, Akiyama H, Onishi E, Nakamura T (2007) Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years. J Bone Joint Surg (Br) 89(1):26–31. doi:10.1302/0301-620X.89B1.18037 CrossRef Kawanabe K, Akiyama H, Onishi E, Nakamura T (2007) Revision total hip replacement using the Kerboull acetabular reinforcement device with morsellised or bulk graft: results at a mean follow-up of 8.7 years. J Bone Joint Surg (Br) 89(1):26–31. doi:10.​1302/​0301-620X.​89B1.​18037 CrossRef
21.
Zurück zum Zitat Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168CrossRefPubMed Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168CrossRefPubMed
22.
Zurück zum Zitat Hori J, Yasunaga Y, Yamasaki T, Yoshida T, Oshima S, Yamasaki K, Matsuo T, Ochi M (2012) Mid-term results of acetabular reconstruction using a Kerboull-type acetabular reinforcement device. Int Orthop 36(1):23–26. doi:10.1007/s00264-011-1248-0 CrossRefPubMed Hori J, Yasunaga Y, Yamasaki T, Yoshida T, Oshima S, Yamasaki K, Matsuo T, Ochi M (2012) Mid-term results of acetabular reconstruction using a Kerboull-type acetabular reinforcement device. Int Orthop 36(1):23–26. doi:10.​1007/​s00264-011-1248-0 CrossRefPubMed
Metadaten
Titel
Acetabular reconstruction with a reinforcement device and bone grafting in revision arthroplasty—a mean five years of follow-up
verfasst von
Ancuța Zazgyva
Sándor-György Zuh
Ciprian Oliviu Roman
István Gergely
Tudor Sorin Pop
Publikationsdatum
07.11.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 8/2016
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-015-3030-1

Weitere Artikel der Ausgabe 8/2016

International Orthopaedics 8/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.