Abstract
Reconstruction of severe pelvic bone loss is a challenging problem in hip revision surgery. Between January 1992 and December 2000, 97 hips with periprosthetic osteolysis underwent acetabular revision using bulk allografts and the Burch-Schneider antiprotrusio cage (APC). Twenty-nine patients (32 implants) died for unrelated causes without additional surgery. Sixty-five hips were available for clinical and radiographic assessment at an average follow-up of 14.6 years (range, 10.0 to 18.9 years). There were 16 male and 49 female patients, aged from 29 to 83 (median, 60 years), with Paprosky IIIA (27 cases) and IIIB (38 cases) acetabular bone defects. Nine cages required rerevision because of infection (3), aseptic loosening (5), and flange breakage (1). The average Harris hip score improved from 33.1 points preoperatively to 75.6 points at follow-up (P < 0.001). Radiographically, graft incorporation and cage stability were detected in 48 and 52 hips, respectively. The cumulative survival rates at 18.9 years with removal for any reason or X-ray migration of the cage and aseptic or radiographic loosening as the end points were 80.0% and 84.6%, respectively. The use of the Burch-Schneider APC and massive allografts is an effective technique for the reconstructive treatment of extensive acetabular bone loss with long-lasting survival.
Highlights
IntroductionRevision of the acetabular component of a total hip arthroplasty (THA) with associated bone loss is a complex challenge, due to the difficulty to obtain a primary stability and to reconstitute periprosthetic bone stock.Minor, cavitary bone defects can be successfully treated by porous-coated, hemispherical cups [1, 2].the optimal option for management of uncontained deficiencies is still a controversial issue, because stable fixation and long-term bone ingrowth are not reliable.Filling acetabular bony cavities with massive allografts resulted in early failure due to resorption of the graft [3,4,5,6,7].Segmental acetabular defects involving both columns with more than 50% of the graft supporting the cup suggest the application of ilioischial devices [8,9,10,11,12,13].The antiprotrusio cage (APC) was originally designed by Burch in 1974 and later modified by Schneider in 1975 to manage protrusion acetabuli
The aim of this study was to evaluate the minimum 10year clinical and radiographic outcome of massive allografts combined with the Burch-Schneider antiprotrusio cage for the management of severe combined deficiencies in failed total hip arthroplasty
Of the acetabular component was associated with severe resorption of the original graft, indicating the failure of the reconstructive treatment
Summary
Revision of the acetabular component of a total hip arthroplasty (THA) with associated bone loss is a complex challenge, due to the difficulty to obtain a primary stability and to reconstitute periprosthetic bone stock.Minor, cavitary bone defects can be successfully treated by porous-coated, hemispherical cups [1, 2].the optimal option for management of uncontained deficiencies is still a controversial issue, because stable fixation and long-term bone ingrowth are not reliable.Filling acetabular bony cavities with massive allografts resulted in early failure due to resorption of the graft [3,4,5,6,7].Segmental acetabular defects involving both columns with more than 50% of the graft supporting the cup suggest the application of ilioischial devices [8,9,10,11,12,13].The antiprotrusio cage (APC) was originally designed by Burch in 1974 and later modified by Schneider in 1975 to manage protrusion acetabuli. Cavitary bone defects can be successfully treated by porous-coated, hemispherical cups [1, 2]. The optimal option for management of uncontained deficiencies is still a controversial issue, because stable fixation and long-term bone ingrowth are not reliable. Filling acetabular bony cavities with massive allografts resulted in early failure due to resorption of the graft [3,4,5,6,7]. Segmental acetabular defects involving both columns with more than 50% of the graft supporting the cup suggest the application of ilioischial devices [8,9,10,11,12,13]. The aim was to bridge areas of bone loss, providing immediate mechanical fixation
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