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Current Construct Options for Revision of Large Acetabular Defects: A Systematic Review
Marieke Baauw1, Miranda L van Hooff, Maarten Spruit
1Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.
JBJS Reviews
|December 7, 2016
Summary
For large acetabular defects, Trabecular Metal augments and shells show promising results for revision surgery. Other techniques like antiprotrusio cages are suitable for specific patient groups.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Medical Device Technology
Background:
- Revision of large acetabular defects presents significant challenges in hip reconstruction surgery.
- Multiple surgical techniques exist, but consensus on the most effective approach remains elusive.
Purpose of the Study:
- To systematically review and evaluate the effectiveness of various interventions for large acetabular defects.
- To compare outcomes such as re-revision rates, radiographic loosening, and clinical results across different surgical techniques.
Main Methods:
- A systematic review adhering to Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.
- Inclusion of 20 studies defining large acetabular defects by American Academy of Orthopaedic Surgeons (AAOS) types III-IV or Paprosky types 3A-3B.
- Quality assessment using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
Main Results:
- Seven treatment options were identified: antiprotrusio cage, Trabecular Metal (Zimmer) augment and shell, bone impaction grafting with metal mesh, hemispherical implant with hook and flanges, Trabecular Metal augment or structural allograft with cup, cup-cage reconstruction, and custom-made triflange component.
- Trabecular Metal augments and shells demonstrated the most favorable re-revision and radiographic loosening outcomes.
- Antiprotrusio cages were frequently reported with good results in elderly, low-demand patients.
Conclusions:
- Trabecular Metal augments and shells appear to be a highly effective option for managing large acetabular defects.
- Antiprotrusio cages are a viable option for specific, lower-demand patient populations.
- For complex defects (Paprosky type-3B), custom triflange implants or cup-cage reconstructions may be alternatives, though further high-quality evidence is needed.
