Cementless Acetabular Revision Research Articles

Acetabular Component Anteversion in Primary and Revision Total Hip Arthroplasty: An Observational Study

Purpose: In a prospective manner to evaluate the range of acetabular component anteversion actually achieved by the use of a cup positioner in cementless revision and primary THA.Methods: We operated 71 patients with cementless primary THA, and 26 patients with cementless acetabular revision surgery. We aimed to obtain cup anteversion of 10 to 30° with an impactor-positioner. In all cases we used elevated liners and a ceramic head with diameter 28. At 3 months postoperatively the component versions were measured using CT with the patient in supine position.Results: The acetabular component version in the primary hips ranged from 28° of retroversion to 42° of anteversion with a mean of 17.4 ± 14.0°, while the cup version in the revision hips ranged from 4° of retroversion to 32° of anteversion with a mean of 15.0 ± 9.6°(p=0.427). The anteversion of 40 (56%) of the primary acetabular components were within the target zone of 10 to 30°, while 19 (27%) were below the target zone and and 12 (17%) were above the target range. The anteversion of 19 (73%) of the revision acetabular components were within the target zone, while 6 (23%) were below the target zone and 1 (4%) were above the target range. The differences in distribution between the primary and revision operations were not significant (p=0.183).Conclusions: The intraoperative estimation of acetabular anteversion by free hand technique in many cases was not within the intended range of 10 to 30° in either primary or revision THA and with no differences between the two series

Initial Implant Stability Predicts Migration But Not Failure in Cementless Acetabular Revision with Bone Grafting

Host bone contact of less than 50% is perceived but not proven to cause migration and loosening after actetabular revision. A prospective analysis of cementless acetabular revision cases with impaction grafting was performed to determine if this was an independent risk factor for these events. Sixty-two hips in 54 patients were assessed at a mean follow-up of 84.5months (range 61–112) yielding a probability of 94.6% of retaining the acetabular component using revision for aseptic loosening as the end point. No single factor was independently causative for loosening, although Type III fixation was associated with migration (p=0.0159); subanalysis suggested that achieving host–bone contact in at least part of the dome and posterior column is important.

Cementless acetabular revision: past, present, and future

Acetabular revision is probably the most difficult aspect of hip reconstructive surgery. Although the majority of acetabular revisions can be performed using an uncemented hemispherical acetabular device with ancillary fixation, patients with severe acetabular deficiencies and poor bone quality require more complex alternatives for revision. The limitations of traditional cementless acetabular implants has promoted the development of improved methods of fixation and revision techniques. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimising biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This review focuses on the use of cementless implants for acetabular revision. The use of trabecular metal cups, augments, jumbo cups, oblong cups, cages, and structural grafting are also discussed.

Large Acetabular Defects Can be Managed with Cementless Revision Components

Optimal techniques for acetabular revision in the setting of major pelvic osteolysis have not been established. Bilobed components, structural grafts, and reinforcement cages have demonstrated 10-24% midterm failure rates. While cementless hemispherical components have been utilized to treat large acetabular defects, most reports have not focused specifically on patients with extensive deficiencies. We report midterm clinical scores, component revisions, and complications following focal bone grafting and cementless acetabular revision in cases with major periacetabular osteolysis. We identified 30 patients (32 hips) who underwent cementless acetabular revision to treat massive acetabular bone loss at an average followup of 53 months. We excluded three patients lost to followup and two patients who died prior to minimum 24 month followup. Harris Hip Scores were assessed before and after surgery. Postoperative radiographs were evaluated for graft incorporation and component migration. Component revision and component migration are reported as failures. Mean Harris Hip Score improved from 52.5 (range, 17.7-90.7) to 87.3 (range, 25.3-100) points. Three hips (9%) were revised for aseptic loosening. Three components (10.7%) demonstrated radiographic migration, but were not revised. Complete graft incorporation was seen in 17 cases (68%). There were five major complications (14%). Cementless acetabular fixation and bone grafting result in clinical scores and survivorship comparable to other options at midterm followup, with potential for biological fixation. Level IV, clinical research study. See the Guidelines for Authors for a complete description of levels of evidence.

Modularity of a new cementless acetabular revision cup system based on research of the anatomic variability of the pelvis

There is a growing need for specific revision implants to meet the increasing occurrence of failed total hip arthroplasties displaying massive deficiencies in acetabular bone stock. The developed acetabular revision cup presented in this study is aimed at individual patient solutions using a multi-axial and angular stable fixation peg as well as a modular adaptable lateral flap. To obtain an optimum implant design, a database of computed tomography scans of 69 patients' pelves was collected and computational reconstruction of the pelvic bone morphology was conducted. Based on the anatomic measurements, the direction of the fixation peg of the revision cup was evaluated using custom software and the geometry of the lateral flaps was evaluated using rapid prototyping models of the pelvis. Furthermore, we conducted preclinical examinations of the acetabular revision system with regard to the safety of the angular stable locking mechanism of the fixation pegs and the mechanical stability of the lateral flap. The dynamic tests showed no mechanical failure of the fixation peg and its angular stable connection using a cyclic maximum torque of 24.5 Nm for one million cycles. The lateral flap and its fixation showed no mechanical failure using a cyclic maximum torque of 28.4 Nm for two million cycles. In conclusion, a promising solution to satisfy the requirements for adequate anatomical fit in a wide range of acetabular defects is presented.

Cementless Acetabular Socket Revisions Using Metasul Metal-on-Metal Bearings

Thirty-four hips were treated with cementless acetabular socket revisions using a metal-on-metal bearing. The causes of revision were aseptic loosening in 33 hips and septic loosening in 1 hip. Revisions were performed for acetabular sockets in 28 hips and for acetabular sockets and femoral stems in 6 hips. Mean follow-up duration was 6.2 years (range, 4.0-9.1 years), and mean Harris Hip Scores improved from 56 to 92 points. No hip required further revision for aseptic loosening. Focal femoral osteolysis newly developed in zone I in 1 hip, which was treated by curettage and bone grafting. The authors suggest that second-generation metal-on-metal bearings in cementless acetabular socket revisions can achieve good medium-term clinical and radiographic results.

Clinical and radiographic assessment of cementless acetabular revision with morsellised allografts

The aim of this study was to evaluate the clinical and radiographic results of cementless acetabular revision with deep frozen morsellised allografts. Sixty-one patients (65 hips) underwent acetabular revision using cementless components and deep frozen morsellised allografts. Fifty-seven hips (53 patients) were reviewed at a mean of 105.1 months (range 72-180 months) after revision. The study group included 29 males and 24 females with a mean age of 46.4 years. One cup underwent further revision for aseptic loosening and two were defined as radiographic failures. The mean time for allograft incorporation was 12.5 months (range 6-24 months) after index surgery. The mean Harris hip score of the patients improved from 61.1 points preoperatively to 91.6 points postoperatively. Linear and cavitary osteolysis was observed in two and 12 hips, respectively. The acetabular revision using cementless components with deep frozen morsellized allografts provides favourable clinical and radiographic results, although the initial disease and age may adversely affect the outcomes.

Cementless Acetabular Revision Using a Third Generation Porous-Coated Component: Evaluation at 5 to 11-Year Follow up

Previous studies have demonstrated excellent survivorship for cementless acetabular fixation in revision total hip arthroplasty (THA). As implants and surgical techniques evolve, these changes may be associated with unanticipated deleterious effects on component survivorship. Our purpose is to describe the results of acetabular revision using a third generation cementless component that is in wide use today.

Acetabular Revision With Bone Graft and Cementless Cup

Cementless acetabular components are routinely used in revision hip surgery. Nevertheless, few investigators have assessed their retention and efficacy over the long term. This occurs mainly in cases which originate from moderate to severe bone losses (cavitary and or segmental) requiring the use of morselized and or bulk bone graft. Our objective in the present study is to report the outcome of 42 patients with 43 cementless acetabular revisions with bone graft who were operated by the same surgeon. The report is based on the clinical and radiographic evaluation of the patients alive at 167 months of follow-up.

Porous tantalum uncemented acetabular shells in revision total hip replacement: Two to four year clinical and radiographic results

In cementless revision total hip arthroplasty (THA), achieving initial implant stability and maximising host bone contact is key to the success of reconstruction. Porous tantalum acetabular shells may represent an improvement from conventional porous coated uncemented cups in revision acetabular reconstruction associated with severe acetabular bone defects. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects done with a hemispheric, tantalum acetabular shell and multiple supplementary screws. At a mean follow-up of 40 (24-51) months, one acetabular shell had been revised in a patient with a Paprosky 3B defect. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent early clinical and radiographic results and warrants further evaluation in revision acetabular reconstruction associated with severe acetabular bone defects.

Porous tantalum uncemented acetabular shells in revision total hip replacement: two to four year clinical and radiographic results

In cementless revision total hip arthroplasty (THA), achieving initial implant stability and maximising host bone contact is key to the success of reconstruction. Porous tantalum acetabular shells may represent an improvement from conventional porous coated uncemented cups in revision acetabular reconstruction associated with severe acetabular bone defects. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects done with a hemispheric, tantalum acetabular shell and multiple supplementary screws. At a mean follow-up of 40 (24-51) months, one acetabular shell had been revised in a patient with a Paprosky 3B defect. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent early clinical and radiographic results and warrants further evaluation in revision acetabular reconstruction associated with severe acetabular bone defects.

Cementless Hemispheric Acetabular Component for Acetabular Revision Arthroplasty: A 5- to 19-Year Follow-Up Study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.

Cementless Acetabular Revision Performed with Morselized Bone Grafts:A Ten-Year Minimum Follow-Up

Cementless Acetabular Revision Performed with Morselized Bone Grafts:A Ten-Year Minimum Follow-Up

The Incorporation of Morselized Bone Grafts in Cementless Acetabular Revisions

The treatment of large osteolytic lesions is a challenge during acetabular revisions. Periprosthetic bone loss can compromise the stability of new implants. The purpose of this study was to evaluate the 5- to 10-year clinical and radiographic results of morselized bone grafting for acetabular osteolysis during cementless acetabular revisions. Ninety-nine patients (108 hips) who had an acetabular revision hip arthroplasty for osteolysis were retrospectively reviewed. There were 44 men and 55 women who had a mean age of 66 years. At the index revision, the acetabular defects were debrided of granulomatous tissue and packed tightly with morselized cancellous femoral head allograft. All the revision acetabular components were implanted using cementless fixation. At a mean followup of 85 months (range, 60-118 months), the results of 103 of 108 hips (95%) were clinically and radiographically successful. The mean preoperative Harris hip score was 37 points, which improved to a mean of 91 points at the last followup. All cavitary defects had complete radiographic incorporation of the bone grafts except for two lesions. The results of this study indicate that morselized bone graft incorporates into cementless acetabular revisions. This treatment method provided a stable reconstruction in 98% of patients at a mean of 7 years followup.

Cementless acetabular revision with the Harris-Galante porous prosthesis. Results after a minimum of ten years of follow-up.

Revisions of the acetabular component of a total hip arthroplasty have a higher rate of complications, particularly loosening and dislocation, than do primary procedures. The purpose of this study, in which the results of a consecutive series of revisions performed with the Harris-Galante Porous acetabular component by a single surgeon were evaluated at an average of twelve years, was to quantify the complications and outcomes of acetabular revision. Clinical and radiographic results were evaluated to assess loosening, lysis, radiolucencies, and trochanteric union in 188 hips (170 patients) treated between 1984 and 1990. One hundred and twenty-two hips in 110 patients were followed for at least ten years, which was required for inclusion in the study. Thirty-one patients (thirty-six hips) died less than ten years postoperatively, and twenty-nine patients (thirty hips) were lost to or refused to return for follow-up. The average Harris hip score was 78 points at an average of 12.5 years after revision, which was a 29-point improvement compared with the preoperative score. The rate of repeat revision because of aseptic loosening of the acetabular shell was 4% (five of 122). The rate of repeat revision of the shell for any reason was 15% (eighteen of 122). Eight unrevised sockets were loose radiographically, for a total rate of aseptic loosening of 11% (thirteen of 122). This study demonstrated that most acetabular revisions with this cementless hemispherical socket were successful. Few structural grafts and no cages were used. Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Cementless acetabular reconstruction in revision total hip arthroplasty.

Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions. We reviewed the results of 138 consecutive acetabular revisions done with a hemispheric, cementless acetabular component that is sintered with Ti fiber metal mesh and was inserted with line-to-line reaming and multiple screws for fixation. At a mean of 15 years, 19 acetabular components had been revised (13.8%); seven were revised for recurrent instability, six were revised for deep periprosthetic infection, five well-fixed cups were removed at the time of femoral revision, and one cup was fixed by fibrous tissue only at the time of femoral revision and was removed. One acetabular component was radiographically loose. Survivorship of the component was 81% at 15 years when revision for any reason was considered as an end point and 96% when revision for loosening or radiographic evidence of loosening was considered as a second end point. Cementless acetabular revision provides durable results at 15 years with a low rate of failure for loosening.

Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions.

There are few longer-term follow-up reports of the results and complications of the use of cementless acetabular components in revision hip arthroplasty. In this study, we analyzed the clinical and radiographic results to determine the factors that affect longer-term survival of titanium-fiber-metal-coated acetabular components. During a fourteen-year period, one surgeon performed 211 consecutive unselected cementless acetabular revisions in 194 patients with a mean age of sixty-two years. The same technique was used for all revisions: the component was impacted and was fixed with multiple screws, and bone deficiencies were augmented with supplemental bone graft. Both the acetabular and the femoral components were revised in 142 hips, whereas an isolated acetabular revision was performed in sixty-nine hips. All 211 revisions were included in a survivorship analysis to twelve years. Prospectively determined clinical results in 135 hips and radiographic results in 131 hips were available at a minimum of five years postoperatively. Seven acetabular components were removed: three, because of infection; one, because of recurrent dislocation; and three, because of mechanical loosening. There was asymptomatic radiographic loosening of one additional acetabular component, for a total rate of aseptic loosening of 2%. The twelve-year prosthetic survival rate was 95% (95% confidence interval, 91% to 99%), with failure defined as component removal for any reason. There was no significant difference in the rate of survival of the cup or femoral component between the sixty-nine hips treated with isolated acetabular revision and the 142 hips in which both components were revised. There was a significant difference in the rate of dislocation between the hips treated with isolated acetabular revision (dislocation in fourteen hips, 20%) and those in which both components had been revised (dislocation in eleven hips, 8%; p = 0.03), but there was no difference in component survival if a dislocation occurred. There was a significant association between a patient weight of >82 kg and acetabular failure (p = 0.04). This titanium-fiber-metal-coated hemispheric component fixed with multiple screws had a twelve-year survival rate of 95% when used in an unselected, consecutive series of acetabular revisions. The rate of dislocation was significantly higher in the patients treated with isolated acetabular revision, and routine postoperative bracing is now recommended for that group.

Use of cancellous bone chips and demineralized bone matrix in the treatment of acetabular osteolysis: preliminary 2-year follow-up.

Twenty patients (20 hips) who had cementless acetabular revision arthroplasty and were treated with cancellous bone chips mixed with demineralized bone matrix to fill the cavitary defects were studied. At 2-years' follow-up, the grafts were fully incorporated in 18 patients. In addition, the mean Harris Hip Score increased to 89 points from a mean preoperative score of 29 points for the surviving hips. These preliminary findings suggest that the prepackaged demineralized bone matrix and cancellous chips can provide acceptable radiographic and clinical results as an adjunct in the treatment of contained osteolytic acetabular defects.

Acetabular revision without cement

We reviewed the clinical and radiologic results of 47 cementless acetabular revisions performed by a single surgeon. The mean follow-up period was 58 months. The American Academy of Orthopaedic Surgeons (AAOS) acetabular defect classification was type I in 4 hips, type II in 9 hips, and type III in 32 hips. All patients received AML (Depuy, Warsaw, IN) Duraloc cup implants. Morcellized allograft was used in 23 hips (49%), and screw augmentation in 22 hips (47%). The Harris Hip score improved from 72 to 90 points. No revisions were performed for aseptic loosening. Nonprogressive thin radiolucent lines were found in a single zone in 10 hips (21%) and in all 3 zones in 5 hips (11%). No migration was found in any cups with radiolucent lines, and the presence of a radiolucent line was considered clinically unimportant. Progressive loosening with migration of the cup was found in 1 hip (2%). Kaplan-Meier survivorship using revision for aseptic loosening or radiologic loosening as end points was 92% at 72 months. No statistically significant difference was found in the survival of the cups fixed with or without screws. These encouraging midterm results confirm the role of cementless acetabular revision.

Cementless acetabular revision for elderly patients

Cementless acetabular revision for elderly patients