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Long-term functional results of revision hip replacement using Burch-Schneider cages
Valeriy Murylev1,2, Alexey Muzychenkov1,2, Pavel Elizarov1,2
1I.M.Sechenov First Moscow State Medical University Sechenov University), Department of Traumatology, Orthopedics and Disaster Surgery, Moscow, 119991, Russian Federation.
Insights
The Burch-Schneider cage is effective for revision total hip arthroplasty (THA) in cases of aseptic loosening, showing good long-term functional outcomes. This anti-protrusion system remains a valuable option for complex hip reconstructions.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Total hip arthroplasty (THA) is a common treatment for end-stage hip osteoarthritis.
- Burch-Schneider cages are frequently used in revision THA, with over 125,000 implanted by 2006.
Purpose of the Study:
- To retrospectively analyze the use of Burch-Schneider anti-protrusion cages in revision THA.
- To evaluate the long-term functional results of revision THA using these cages.
Main Methods:
- Retrospective analysis of 58 revision THA surgeries using Burch-Schneider cages for aseptic loosening.
- Patient follow-up up to 17 years, with functional assessment using Harris, WOMAC, SF-36, and FJS-12 scales.
- Classification of patients according to the Paprosky criteria (2C, 3A, 3B).
Main Results:
- Good functional results were observed across Paprosky groups 2C, 3A, and 3B, with high Harris and FJS-12 scores.
- Satisfactory functional outcomes were noted in Group 3B, despite being a more complex case.
- 16 patients required re-revision surgery due to periprosthetic infection (5), aseptic loosening (7), or fracture (3).
Conclusions:
- The Burch-Schneider anti-protrusion system is a valid and effective option for revision THA, particularly for acetabular bone defects.
- Despite advancements in surgical technology, Burch-Schneider cages remain relevant for specific indications in complex hip revision procedures.
- Key indications include acetabular roof bone defects and acetabular floor bone mass loss.
Introduction:
One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results.
Methods:
Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B.
Results:
Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3.
Conclusions:
The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.
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