Trabecular Metal Augments for the Management of Paprosky Type III Defects Without Pelvic Discontinuity: Average 11-Year Follow-Up in Cases with Previously Reported 4-Year Clinical Results

Abstract

This retrospective case series aimed to assess the clinical and radiographic outcomes of revision total hip arthroplasty with trabecular metal (TM) augments associated with cementless TM acetabular components for the management of Paprosky type IIIA and IIIB defects without pelvic discontinuity. There were 83 hips (82 patients) enrolled. There were 53 patients who completed the clinical and radiological follow-up (64% of the total) who had a mean follow-up of 11 years (range, seven to 16.6). There were seven patients who died during the follow-up period without undergoing further revision, and 23 were lost to follow-up. A Paprosky type IIIA defect was found in 42 hips, whereas a Paprosky type IIIB defect was present in 11 hips. We previously reported short-term outcomes for 55 hips that underwent acetabular reconstruction using TM cups associated with TM augments with a mean follow-up of 53.7 months. Here, we followed the clinical and radiological outcomes of the aforementioned patients and 28 more hips. We retrospectively collected the clinical and radiological data of all the patients operated on in our tertiary referral center between 2005 and 2016. The average Harris Hip Score (HHS) increased from 36.4 (range, 24 to 53) preoperatively to 87.4 (range, 63 to 100) at the last follow-up. The cumulative survival of the acetabular construct at seven years of follow-up was 90.6% (95% CI [confidence interval]: 78.8 to 95.9) considering revision for any reason, and at 10 years of follow-up was 86.3% (95% CI: 73.4 to 93.2). The cumulative survival of the acetabular construct at seven years of follow-up was 94.2% (95% CI: 83.2 to 98.1) considering revision for aseptic loosening, and at 10 years of follow-up was 92.1% (95% CI: 80.4 to 97). The use of TM cups and augments could be considered an effective management of Paprosky type III defects without pelvic discontinuity. The present technique provides an anatomical reconstruction of the defect with the restoration of the hip center of rotation (COR) associated with good clinical and radiographic outcomes in the mid-term.