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Outcomes and prognostic factors in revision hip arthroplasty for severe intra-pelvic cup protrusion: 246 cases
J-A Epinette1, P Mertl2, B Combourieu3
1Clinique Médico-Chirugicale, 200, rue d'Auvergne, 62700 Bruay-Labuissière, France.
Insights
Revision total hip arthroplasty for intra-pelvic cup protrusion requires focus on mechanical stability over ideal hip center restoration. This study found that achieving stable fixation is more critical for long-term outcomes than precisely repositioning the hip center.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Biomedical Engineering
Background:
- Intra-pelvic cup protrusion is a challenging complication following total hip arthroplasty (THA).
- Outcomes and optimal surgical strategies for revision THA in these cases remain unclear.
- This study addresses severe cases requiring complex acetabular reconstruction.
Purpose of the Study:
- To clarify surgical strategies for revision THA due to intra-pelvic cup protrusion.
- To evaluate the impact of hip lever arm and cup mechanical fixation on reconstruction outcomes.
- To test the hypothesis that restoring the anatomic hip center reduces recurrent loosening.
Main Methods:
- Retrospective analysis of 246 revision THA procedures in 220 patients.
- Bone loss assessed using SOFCOT and Paprosky classifications.
- Radiographic evaluation of cup correction and hip center of rotation position.
Main Results:
- Cup protrusion was corrected in all cases; normal cup position achieved in 11%.
- Hip center of rotation was within 10mm of physiological in 64.2% of cases.
- Cumulative survival rates at 13.6 years showed 63.9% survival with cup loosening as endpoint; 9.8% required revision for failure.
Conclusions:
- Restoring the anatomic hip center did not significantly correlate with reduced recurrent loosening.
- Long-term mechanical stability of the acetabular cup is paramount for successful revision THA.
- Recurrent aseptic loosening was the primary cause of failure in 9.8% of cases.
Background:
The outcome of revision total hip arthroplasty (THA) for intra-pelvic cup protrusion is unclear. Hence, we conducted a large retrospective study to clarify the surgical strategy (hip lever arm and cup mechanical fixation) and the outcomes of reconstruction for severe intra-pelvic cup protrusion.
Hypothesis:
We hypothesized that restoration of the anatomic hip centre in such acetabular revisions decreased the risk of recurrent loosening.
Material And Methods:
The study included 246 THA procedures (in 220 patients), with a follow-up of 5.2 ± 4.9 years (1-24.2) after the index surgery. Bone loss was estimated using the SOFCOT classification (grade III or IV in 80% of cases) and the Paprosky classification (IIIA or IIIB in 58% of cases). Quality of the reconstruction was assessed on X-rays according to the correction of the protrusion and position of the hip centre of rotation.
Results:
After a clinical follow-up of at least 5 years, with a mean of 9.9 ± 4.1 years (5-24 years), the mean Postel-Merle d'Aubigné score was 14.2 ± 3.1 and the mean Harris Hip Score was 78.0 ± 18.7. Cup protrusion was partially or completely corrected in every case and cup position was normal in 27 (11%) cases. The centre of rotation was within 10mm of the physiological position in 158 (64.2%) cases, acceptable in 77 (31.3%) cases, ascended in 9 (3.7%) cases, and worsened in 1 (0.4%) case. Revision for cup or cup and femoral failures was required in 24 (9.8%) cases. Cumulative survival rates with cup loosening as the endpoint were 88.5% after 5 years, 79.9% after 10 years, and 63.9% at last follow-up at 13.6 years.
Discussion:
Our hypothesis that restoration of anatomic hip centre decreased the risk of recurrent loosening was not verified: success or failure in restoring the normal centre of rotation did not correlate significantly with final cup status. Recurrent aseptic loosening was the cause of failure in 9.8% of cases. Ensuring long-term effective mechanical stability had a greater impact on global outcomes than restoring an ideal centre of rotation.
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