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Related Experiment Videos

Does a cemented cage improve revision THA for severe acetabular defects?

Erik Hansen1, David Shearer, Michael D Ries

  • 1Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320-W, San Francisco, CA 94143, USA.

Clinical Orthopaedics and Related Research
|September 22, 2010
PubMed
Summary

Cementing acetabular reconstruction cages improves mechanical failure rates in revision total hip arthroplasty (THA) for severe bone loss. Trabecular metal augmentation offers better initial stability than structural allografts for these complex cases.

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Biomaterials Engineering

Background:

  • Revision total hip arthroplasty (THA) is increasing, with significant challenges in cases of large acetabular defects.
  • Severe acetabular bone loss during revision THA is linked to a higher incidence of mechanical failure.

Purpose of the Study:

  • To evaluate if cementing an acetabular reconstruction cage to the pelvis improves mechanical failure rates.
  • To compare outcomes in patients with Type 3 acetabular defects (Paprosky et al.) with and without pelvic discontinuity.

Main Methods:

  • Retrospective analysis of 35 revision THAs in 33 patients with Type 3 acetabular defects.
  • Acetabular reconstruction cages were cemented with morselized allograft and either structural allograft or trabecular metal augmentation.

Related Experiment Videos

  • Follow-up averaged 59 months, with mechanical failure (aseptic loosening) as the primary outcome.

    • Main Results:

    • Mechanical failure requiring revision occurred in 4/13 patients with pelvic discontinuity and 2/22 without.
    • Radiographic loosening was observed in one patient in each group (pelvic discontinuity present/absent).
    • Seven of 35 revisions were revised for deep infection, primarily in immunocompromised patients.

    Conclusions:

    • Cementing acetabular reconstruction cages to the pelvis is advantageous for severe acetabular defects.
    • Trabecular metal augmentation demonstrated superior initial mechanical stability compared to structural allograft.
    • Allograft reconstruction can be successful in restoring bone stock in revision THA.