Cup Cage Research Articles

Porous Metal Augments Have Comparable Outcomes to Other Constructs for Severe Acetabular Bone Loss at Mid-Term Follow-up

BackgroundAcetabular reconstruction options in the setting of severe bone loss remain limited, with few comparative studies published to date. The purpose of this study was to compare the outcomes of revision total hip arthroplasty (THA) for severe bone loss using porous metal augments to cup cage and triflange prostheses. MethodsWe reviewed a consecutive series of 180 patients who had Paprosky 3A or 3B acetabular defects and underwent revision THA. Patients treated with porous augments (n = 141) were compared with those who received cup cages or triflange constructs (n = 39). Failure of the acetabular construct was defined as undergoing acetabular revision surgery or radiographic evidence of loosening. ResultsThere was no difference in acetabular component survivorship in patients undergoing revision THA with porous augments or a cage or triflange prosthesis (92.2 versus 87.2%, P = .470) at a mean follow-up of 6.6 ± 3.4 years. Overall, survivorship free from any revision surgery was comparable between the 2 groups (78.7 versus 79.5%, P = .720). There was also no difference in dislocation (5.7 versus 10.3%, P = .309) or periprosthetic joint infection rates (7.8 versus 10.3%, P = .623). In a subgroup analysis of patients who had pelvic discontinuity (n = 47), survivorship free from any revision surgery was comparable between the 2 groups (79.5 versus 72.2%, P = .543). ConclusionsPorous metal augments in the setting of severe acetabular bone loss demonstrated excellent survivorship at intermediate-term (mean 6.6 years follow-up, even in cases of pelvic discontinuity, with comparable outcomes to cup cages and triflanges. Instability and infection remain major causes of failure in this patient population, and long-term follow-up is needed.

Acaricidal activity of essential oils for the control of honeybee (Apis mellifera) mites Tropilaelaps mercedesae under laboratory and colony conditions

Tropilaelaps spp. mites are considered a major parasite of honeybees. In this study, essential oils (EOs) of 11 plant species were evaluated for acaricidal activity under laboratory and field conditions. Five adult mites per petri dish and ten adult worker bees per plastic cup cage were exposed to different concentrations of each essential oil (0.1, 0.5, 1.0, 5.0, and 10.0% (v/v)). The essential oil of Piper betle (betel) showed the highest acaricidal activity in laboratory testing. Additionally, most EOs showed low toxicity to adult honeybees in a lab assay. Piper betle, Amomum krervanh, and Zanthoxylum limonella were then tested in whole colonies using cardboard strips soaked in 10 mL of each essential oil at various concentrations, every week for 4 weeks. Amomum krervanh at 10% (v/v) and P. betel at 5.0% (v/v) decreased mite populations after 30 days. We further tested grease and a sponge as application methods to deliver A. krervanh, with no significant impact on mites. Although several essential oils demonstrated acaricidal activity against Tropilaelaps under laboratory conditions, the EOs tested did not significantly reduce mites under colony conditions. Therefore, the concentration and colony delivery methods of these promising EOs warrant further investigation.

Survival Analysis of Allografting and Antiprotrusio Cage in Treating Massive Acetabular Bone Defects

BackgroundMassive acetabular bone defects reconstructed with allografting and antiprotrusio cage in revision hip arthroplasty is less reported in the literature. We here report a series of 84 antiprotrusio cages and analyze the risk factors associated with failure. MethodsAll instances of use of an antiprotrusio cage for massive acetabular defect (Paprosky type IIc, III, and pelvic discontinuity) between 2002 and 2017 in the authors’ institute were reviewed after institutional review board’s approval. Survival analyses based on clinical data, bone defect (Paprosky system), type of allograft, size of cage, fixation quality, and position of cage were performed. Failure was defined as cage loosening or breakage, poor hip function, or cage revision for any reason. ResultsA total of 84 cages in 77 patients (mean age, 62.9 years), with a mean follow-up period of 6.2 years, had a survival rate of 82.1%. Failure was noted in 15 hips, including mechanical failure in 8 hips, recurrent dislocation in 1 hip, poor hip function in 1 hip, and periprosthetic joint infection in 5 hips. Pelvic discontinuity, reconstruction with morselized allograft alone, and fewer than 4 fixation points to the host bone were associated with higher failure rates (hazard ratios, 4.02, 3.42, and 9.9, respectively). ConclusionWe found that an antiprotrusio cage combined with strut allografts, fixed securely to the host bone (>4 fixation points), are beneficial for the management of massive acetabular bone defects. However, pelvic discontinuity remains a challenge that warrants the further study of technical or prosthetic innovations, such as triflange implants, cup cage, and 3D-printed implants.

Cup-Cage Solution for Massive Acetabular Defects: A Systematic Review and Meta-Analysis.

Our systematic review compiled multiple studies and evaluated survivorship and clinical outcomes of cup‐cage construct usage in the management of massive acetabular bone defects. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Various combinations of “acetabular”, “pelvis”, “cup cage” and their corresponding synonyms were used to search relevant articles in the Cochrane, EMBASE, and PubMed databases. Basic information of the functional scores, implant revision rate, and complication rate were selected as outcomes for analysis. Finally, a total of 11 articles published between 1999 and 2019 were selected, which include 232 patients with an average age of 68.5 years (range, 30–90). The mean follow‐up period was 48.85 months (range, 1–140). Our study shows that the cup‐cage construct has a good clinical outcome with a low revision rate and a low complication rate. Improved clinical outcomes of cup‐cage constructs were seen with a revision rate of 8% and an all‐cause complication rate of 20%. The most commonly reported complication was dislocation, followed by aseptic loosening, infection, and nerve injuries. In summary, it is a promising method for managing large acetabular bone defects in total hip revision.

Assessing New Tools for Management of the Pepper Weevil (Coleoptera: Curculionidae) in Greenhouse and Field Pepper Crops.

The pepper weevil, Anthonomus eugenii Cano, is an economically important pest of field and greenhouse pepper crops in North America. In this study, a series of insecticides covering a broad-spectrum of insecticidal modes of action were assessed for their potential in managing the pepper weevil under laboratory and greenhouse conditions. To accomplish this, laboratory mini-spray tower and greenhouse cage trials were conducted that evaluated the efficacy of 16 conventional, reduced-risk, and microbial insecticides. In laboratory trials, adult weevils were sprayed with insecticides, placed on treated leaves within a cup cage, and were monitored for their survival over 10 d. Of the 16 insecticides tested, 8 provided greater than 60% weevil control, a threshold considered necessary for including products in further greenhouse testing. In greenhouse trials, adult weevil mortality, bud and foliar damage, bud and fruit abortion, and subsequent weevil offspring emergence were measured following each of three weekly insecticide applications. The most efficacious insecticides included kaolin clay and mineral oil, which performed as well as the thiamethoxam-positive control, and incurred 70 and 55% of adult weevil mortality, respectively. Additionally, kaolin clay and mineral oil reduced offspring weevil emergence by 59 and 54%, respectively, compared with untreated controls. Despite the clear challenge that controlling this pest represents, this study has identified useful new tools for the integrated management of the pepper weevil, which may accelerate the rate at which these become available for use in greenhouse and field pepper production.

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity.

Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cup-cage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges. We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution. All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection. The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 preoperatively to 13 postoperatively (p < 0.001). Four CC had nonprogressive radiological migration of the ischial flange and they remain stable. We believe that the CC construct is a suitable choice to treat chronic pelvic discontinuity; it also remains a reliable option for the treatment of severe acetabular bone defects if stable fixation cannot be obtained through the use of a trabecular metal cup with or without augments. Level IV, therapeutic study.

Pelvic discontinuity

Pelvic discontinuity represents a rare but challenging problem for orthopaedic surgeons. It is most commonly encountered during revision total hip replacement, but can also result from an iatrogentic acetabular fracture during hip replacement. The general principles in management of pelvic discontinuity include restoration of the continuity between the ilium and the ischium, typically with some form of plating. Bone grafting is frequently required to restore pelvic bone stock. The acetabular component is then impacted, typically using an uncemented, trabecular metal component. Fixation with multiple supplemental screws is performed. For larger defects, a so-called 'cup-cage' reconstruction, or a custom triflange implant may be required. Pre-operative CT scanning can greatly assist in planning and evaluating the remaining bone stock available for bony ingrowth. Generally, good results have been reported for constructs that restore stability to the pelvis and allow some form of biologic ingrowth.

Cup–cage construct for acute fractures of the acetabulum, re-defining indications

Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically, the areas of morsellised autograft that surrounded the cups were seen to have incorporated uniformly well, and the acetabular fractures were healed within six months after surgery.No mechanical failure, screw breakage, loosening, or migration was noticed.This novel indication of the cup–cage construction that uses revision techniques, for selected patients and fractures, to achieve an acute stable reconstruction, should be considered as an alternative reconstruction option in elderly patients presenting with acetabular fractures.

Cup–Cage Solution for Pelvic Discontinuity

The cup-cage reconstruction is indicated in massive acetabular bone loss with or without pelvic discontinuity during revision hip arthroplasty. We report the results of 26 pelvic discontinuities treated by this technique at a mean follow up of 46.6 months. The average Harris hip score was 76.6. Three constructs failed all within the first postoperative year. Complications included one deep infection, two dislocations and one peroneal neuropathy. Cup-cage construct is a reliable technique for treating pelvic discontinuity in mid-term follow-up.

The Current Role of Structural Grafts and Cages in Revision Arthroplasty of the Hip

Treating large segmental acetabular defects that comprise more than 50% of the acetabulum is one of the most difficult challenges in revision arthroplasty of the hip. One of the surgical options is a structural acetabular allograft. Unless these allografts are protected by a cage that extends from ilium to ischium, there is an unacceptable incidence of graft failure. The cage allows reconstruction at the correct anatomic level. It provides a scaffold for bone grafting (structural and morsellized). The use of cement to stabilize the cup allows the surgeon to adjust the cup position independent of the cage. The current generation of cages does not provide biologic fixation and with time may loosen or fracture. Recent experience with a combination of a trabecular metal shell protected by a cage may offer a more favorable environment for bone grafting with permanent biologic fixation of the cup cage construct.