The fate of cementless jumbo cups in revision hip arthroplasty

doi:10.1054/arth.2003.50038

The Journal of Arthroplasty

Volume 18, Issue 2, March 2003, Pages 129-133

https://doi.org/10.1054/arth.2003.50038 Get rights and content

Abstract

We report 5-year minimum results of cementless over-sized cups used in revision hip arthroplasty, with significant associated bone defects. Forty-three porous-coated jumbo cups were used to treat acetabular defects in revision hip arthroplasty in 42 patients with a mean age of 63 (range, 25–86). Morsellized allograft only was used in 27 hips, and bulk allograft was used in 8 cases. Two patients were lost to follow-up, and 5 died after a mean 7 years' follow-up, with retention of their prostheses. In the remaining 36 cases, the mean follow-up was 10 years (range, 6–14 years). Two acetabular components were revised for aseptic loosening and graft resorption. Two cases were complicated by dislocation. A satisfactory 92% Kaplan Meier shell survival rate was seen at 14 years. Copyright 2003, Elsevier Science (USA). All rights reserved.

Section snippets

Patients and methods

The study inclusion criteria were cementless acetabular revisions using a jumbo cup in patients with a minimum of 5 years' follow-up. Between 1988 and 1996, 43 revision THAs were performed on 42 patients using 2 types of over-sized cementless acetabular components. There is no clear definition of what constitutes an over-sized or jumbo acetabular cup. Dearborn and Harris ^[6] defined jumbo cups as 66 mm or larger, irrespective of gender. Whaley, Berry, and Harmsen ^[5] used a definition of 66 mm

Results

Radiographs taken 6 weeks after surgery demonstrated a mean abduction angle of 48° (range, 30°–60°). In 11 cases, the socket was uncovered by 0% to 10% of its outer diameter, and in 6 cases the socket was uncovered by 10% to 20%. The remaining cases appeared fully covered on AP pelvis radiograph.

Five patients died after a mean follow-up period of 7 years (range, 3–10), with retention of their prosthesis. The cause of death was unrelated to the surgery. Two patients were lost to follow-up

Discussion

Satisfactory results have been reported with cementless fixation of acetabular sockets in revision hip surgery. Silverton and Rosenberg et al ^[1] reported 89% survival at 100 months follow-up with uncemented components in a revision series of which 80% of acetabuli had morsellized cancellous grafts. Similar results have been reported elsewhere with uncemented components 2, 3, 4.

However, reports on the treatment of acetabular bone deficiencies with oversized cementless sockets in revision THA

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There are more references available in the full text version of this article.

Cited by (73)

Implementing Machine Learning approaches for accelerated prediction of bone strain in acetabulum of a hip joint
2024, Journal of the Mechanical Behavior of Biomedical Materials
The Finite Element (FE) methods for biomechanical analysis involving implant design and subject parameters for musculoskeletal applications are extensively reported in literature. Such an approach is manually intensive and computationally expensive with longer simulations times. Although Artificial Intelligence (AI) based approaches are implemented to a limited extent in biomechanics, such approaches to predict bone strain in acetabulum of a hip joint, are hardly explored. In this context, the primary objective of this paper is to evaluate machine learning (ML) models in tandem with high-fidelity FEA data for the accelerated prediction of the biomechanical response in the acetabulum of the human hip joint, during the walking gait. The parameters used in the FEA study included the subject weight, number and distribution of fins on the periphery of the acetabular shell, bone condition and phases of the gait cycle. The biomechanical response has also been evaluated using three different acetabular liners, including pre-clinically validated HDPE-20% HA-20% Al₂O₃, highly-crosslinked ultrahigh molecular weight polyethylene (HC-UHMWPE) and ZrO₂-toughened Al₂O₃ (ZTA). Such parametric variation in FEA analysis, involving 26 variables and a full factorial design resulted in 10,752 datasets for spatially varying bone strains. The bone condition, as opposed to subject weight, was found to play a statistically significant role in determining the strain response in the periprosthetic bone of the acetabulum. While utilising hyperparameter tuning, K-fold cross validation and statistical learning approaches, a number of ML models were trained on the FEA dataset, and the Random Forest model performed the best with a coefficient of determination (R²) value of 0.99/0.97 and Root Mean Square Error (RMSE) of 0.02/0.01 on the training/test dataset. Taken together, this study establishes the potential of ML approach as a fast surrogate of FEA for implant biomechanics analysis, in less than a minute.
Hip Arthroplasty With the Use of a Reconstruction Cage and Porous Metal Augment to Treat Massive Acetabular Bone Loss: A Midterm Follow-Up
2022, Journal of Arthroplasty
Acetabular reconstruction in the context of massive acetabular bone loss is challenging. In rare scenarios where the extent of bone loss precludes shell placement (cup-cage), reconstruction at our center consisted of a cage combined with highly porous metal augments. This study evaluates survivorship, complications, and functional outcomes using this technique.
Patients with minimum 2-year follow-up were included. Baseline characteristics were collected. Preintervention and postintervention ambulatory scores were collected. Kaplan-Meier (KM) survival analysis for cage failure requiring revision surgery was conducted. Binomial regression analysis was performed to assess for correlation of aseptic cage failure with baseline characteristics. Preintervention and postintervention ambulatory aid requirements were compared.
A total of 41 patients were identified. Mean follow-up was 6.4 years (range 2.8-11.0). Four (9.8%) aseptic cage revisions were identified. Aseptic KM survival analysis was 87.4% (95% confidence interval 75.3-99.6) at 10 years. Aseptic KM survival was 45.0% versus 92.8% at 9 years (P = .14) for patients with vs without pelvic discontinuity. KM survival for all-cause failure was 61.6% (95% confidence interval 44.0-79.2) at 10 years. Binomial regression did not demonstrate correlation of cage failure with baseline characteristics. Wilcoxon signed-rank test demonstrated a significant reduction in ambulatory aide requirement after surgery (mean rank 11.47 vs 9.00, Z = −2.95, P = .003).
In scenarios of massive acetabular bone loss where a cup-cage is not a viable option, good survivorship free from aseptic cage failure can be expected at mid-term follow-up using an antiprotrusio cage combined with porous metal augments. Success requires extensive experience in revision surgery.
Tantalum Augments Combined with Antiprotrusio Cages for Massive Acetabular Defects in Revision Arthroplasty
2020, Arthroplasty Today
Tantalum components have gained popularity for the management of Paprosky type IIIA and IIIB defects during revision total hip arthroplasty. Although the use of antiprotrusio cages solely shows suboptimal results, there are certain defects that still require their use. We hypothesized that combining tantalum augments and an antiprotrusio cage would (1) improve radiographic stability, (2) enhance survivorship, (3) decrease complications, and (4) improve clinical outcomes.
We retrospectively reviewed 20 patients with Paprosky type IIIA or IIIB defects who underwent revision of the acetabular component with a highly porous tantalum augment and an antiprotrusio cage combination. Preoperative and postoperative radiographs, survivorship free from aseptic component revision, and the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36 scores were analyzed. The mean follow-up was 2.8 years.
At the most recent follow-up, no antiprotrusio cages had migrated and all tantalum augments had radiographic evidence of osseointegration. In addition, only 2 components were revised for aseptic etiologies and only 1 was loose. Both were revised secondary to failures of the inferior flange of the antiprotrusio cage. All clinical outcome scores significantly improved postoperatively. Finally, the risk of major postoperative complications was noted to be 10%.
In summary, a tantalum augment combined with an antiprotrusio cage in Paprosky IIIA and IIIB defects with divergent anatomy not amenable to a hemispherical socket provides a reliable technique to restore the anatomic hip center and prevent superior migration and provides a bony ingrowth surface. Longer term follow-up is required before the technique is widely adapted.
Level IV, therapeutic studies.
Topology optimization of 3D-printed structurally porous cage for acetabular reinforcement in total hip arthroplasty
2020, Journal of the Mechanical Behavior of Biomedical Materials
Aseptic loosening and mechanical failure of acetabular reinforcement components are among the main causes of their reduced service life. Current acetabular implants typically feature a structural solid layer that provides load bearing capacity, coated with a foam of uniform porosity to reduce stress shielding and implant loosening. This paper presents an alternative concept for a 3D printed cage that consists of a multifunctional fully porous layer with graded attributes that integrate both structural function and bone in-growth properties. The design comprises a hemispherical cup affixed to a superior flange with architecture featuring an optimally graded porosity. The methodology here presented combines an upscaling mechanics scheme of lattice materials with density-based topology optimization, and includes additive manufacturing constraints and bone ingrowth requirements in the problem formulation. The numerical results indicate a 21.4% reduction in the maximum contact stress on the bone surface, and a 26% decrease in the bone-implant interface peak micromotion, values that are indicative of enhanced bone ingrowth and implant long-term stability.
The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study
2018, Journal of Arthroplasty
Reconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques.
A retrospective review was conducted on 74 consecutive THAs revised using metal augments with a cementless hemispherical cup and 77 consecutive THAs revised using the jumbo cup, all with a minimum 2-year follow-up. Biomechanical parameters were measured before and immediately after the revision. Radiological and clinical outcomes at follow-ups were also evaluated.
The metal augment group had a reconstructed center of rotation (COR) that was 6.5 mm closer to the anatomic COR in height (P < .001), had 3.6 m smaller cup size (P < .001), and had 5.7 mm less head-cup difference (P < .001). Moreover, there was a reconstructed COR that was much closer to the anatomic COR (vertical distance: 1.8 vs 14.1 mm, P < .001; horizontal distance: −2.1 vs 7.9 mm, P = .013), had 4.1 mm greater femoral offset (P = .006), and had 8 mm less leg length discrepancy (P = .035) in the subgroup of Paprosky type III bone defects when compared to the jumbo cup group. All cup-augment constructs were radiologically stable with a higher mean postoperative Harris Hip Score (P = .012). One jumbo cup was radiologically unstable.
In revision THA, utilizing metal augments helps to restore the COR position more precisely, avoid using a larger cup, reduce head-cup difference, rebuild femoral offset, and decrease leg length discrepancy, particularly with Paprosky type III bone defects. Moreover, it provides satisfactory radiological and clinical outcomes in the short term.
Acetabular Revision using Trabecular Metal Augments for Paprosky Type 3 Defects
2018, Journal of Arthroplasty
Trabecular Metal (TM) augments are one option when reconstructing bone loss during acetabular side revision surgery.
We studied 38 consecutive patients with Paprosky type 3 defects that were revised using a TM shell and one or more augments over a 6-year period. There were 29 Paprosky type 3A defects and 9 Paprosky type 3B defects. The mean age of the patients at the time of surgery was 68.2 years (range 48-84). The mean length of follow-up was 36 months (range 18-74).
The mean preoperative short form 12 health survey improved from 27.7 before operation to 30.1 at the time of final follow-up (P = .001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 53 preoperatively to a mean of 78.8 at final follow-up (P < .0001). There was evidence of radiographic loosening in 7 of the cup-augment constructs. One patient developed a deep infection requiring re-revision. Two patients required revision for aseptic loosening.
The use of TM in complex acetabular reconstruction is associated with good outcome in the short to medium term.

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^*: No benefits or funds were received in support of this study.

^**: Reprint requests: J. V. Patel, FRCS, 10 Sutherland Avenue, Ealing W13 8LE, London, UK.

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Original ArticlesThe fate of cementless jumbo cups in revision hip arthroplasty*,**

Abstract

Section snippets

Patients and methods

Results

Discussion

J Arthroplasty

J Arthroplasty

Orthop Clin North Am

J Arthroplasty

Orthop Clin North Am

Revision of the acetabular component without cement after total hip arthroplasty: a follow up note regarding results at seven to eleven years

J Bone Joint Surg Am

Original Articles
The fate of cementless jumbo cups in revision hip arthroplasty*,**