Abstract
BackgroundIn revision hip arthroplasty, managing the large protrusio acetabular defects remains a challenge. The report described a novel technique which employs a trabecular metal revision shell as a super-augment to buttress the superior medial structure.MethodsBetween January 2015 and December 2018, the multicup reconstruction was performed in 21 patients with severe protrusio acetabular defects. The revision shell, plus two similar porous acetabular components was implanted into the initial shell to create a “multicup” construct. The functional outcomes were evaluated in terms of the Harris Hip Score. Acetabular loosening, restoration of hip center of rotation, and bone ingrowth etc., were radiographically assessed. The survival rate of the implants was also evaluated.ResultsA followup lasting a mean time of 31 months (range, 18–57 months) revealed that the average Harris Hip Score improved from preoperative 37.0 ± 7.1 to postoperative 76.4 ± 9.0. There were no revisions due to acetabular loosening. The horizontal offset increased by an average of 14 mm, and the vertical offset decreased by an average of 18 mm. Eighteen of the 21 patients (86 %) met at least 3 of 5 criteria associated with bone ingrowth. The survivorship free from re-revision for acetabular loosening after 2 years was 100 %.ConclusionsThe multicup reconstruction technique was a simplified re-revision procedure for managing the severe protrusio acetabular defects and could achieve a high survival rate.Level of evidenceTherapeutic study, Level IVa.
Highlights
Patel et al [1] estimated that, in England and Wales from 2012 to 2030, the number of total hip revisions will increase by 31 %
Revision hip arthroplasty poses a number of challenges, especially in patients with severe protrusio acetabular defects [2, 3]
Using our institution-based registry database, we identified 274 patients who had undergone revision total hip arthroplasties (THAs) between January 2015 and December 2018
Summary
Patel et al [1] estimated that, in England and Wales from 2012 to 2030, the number of total hip revisions will increase by 31 %. Revision hip arthroplasty poses a number of challenges, especially in patients with severe protrusio acetabular defects [2, 3]. The antiprotrusio cage (2021) 3:26 is most widely used in difficult cases and attains good outcomes [6,7,8,9] This technique is reliable in elderly patients. Using a TM-coated cup for augmentation often permits some degrees of interface fit and an enhanced surface area for bone ingrowth, but hip impingement is a major concern. For these reasons, we developed a new multicup reconstruction technique to simplify the surgery. The report described a novel technique which employs a trabecular metal revision shell as a super-augment to buttress the superior medial structure
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