Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss?
- PMID: 25315276
- PMCID: PMC4294939
- DOI: 10.1007/s11999-014-3969-z
Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss?
Abstract
Background: Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon's ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components.
Questions/purposes: The purposes of this study were to determine the (1) frequency of repeat revision, (2) complications and radiographic findings, and (3) Harris hip scores in patients who underwent complex acetabular revision surgery with custom acetabular components.
Methods: Between August 2003 and February 2012, 26 patients (28 hips) have undergone acetabular reconstruction with custom triflange components. During this time, the general indications for using these implants included (1) failed prior salvage reconstruction with cage or porous metal construct augments, (2) large contained defects with possible discontinuity, (3) known pelvic discontinuity, and (4) complex multiply surgically treated hips with insufficient bone stock to reconstruct using other means. This approach was used in a cohort of patients with Paprosky Type 3B acetabular defects, which represented 3% (30 of 955) of the acetabular revisions we performed during the study period. Minimum followup was 2 years (mean, 57 months; range, 28-108 months). Seven patients (eight hips) died during the study period, and three (11%) of these patients (four hips; 14%) were lost to followup before 2 years, leaving 23 patients (24 hips) with minimum 2-year followup. Sixteen patients were women. The mean age of the patients was 67 years (range, 47-85 years) and mean BMI was 28 kg/m2 (range, 23-39 kg/m2). Revisions and complications were identified by chart review; hip scores were registered in our institution's longitudinal database. Pre- and postoperative radiographs were analyzed by the patient's surgeon to determine whether migration, fracture of fixation screws, or continued bone loss had occurred.
Results: There have been four subsequent surgical interventions: two failures secondary to sepsis, and one stem revision and one open reduction internal fixation for periprosthetic femoral fracture. There were two minor complications managed nonoperatively, but all of the components were noted to be well-fixed with no obvious migration or loosening observed on the most recent radiographs. Harris hip scores improved from a mean of 42 (SD, ±16) before surgery to 65 (SD, ±18) at latest followup (p<0.001).
Conclusions: Custom acetabular triflange components represent yet another tool in the reconstructive surgeon's armamentarium. These devices can be helpful in situations of catastrophic bone loss.
Level of evidence: Level IV, therapeutic study.
Figures
![Fig. 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4294939/bin/11999_2014_3969_Fig1_HTML.gif)
![Fig. 2A–B](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4294939/bin/11999_2014_3969_Fig2_HTML.gif)
![Fig. 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4294939/bin/11999_2014_3969_Fig3_HTML.gif)
Similar articles
-
TOTAL HIP JOINT REPLACEMENT USING A CUSTOM TRIFLANGE ACETABULAR COMPONENT (LITERATURE REVIEW).Wiad Lek. 2023;76(12):2694-2699. doi: 10.36740/WLek202312120. Wiad Lek. 2023. PMID: 38290035 Review.
-
Custom Triflange Acetabular Components For Catastrophic Bone Loss: Minimum 5-Year Results.J Arthroplasty. 2023 Jul;38(7):1330-1334. doi: 10.1016/j.arth.2023.01.023. Epub 2023 Jan 25. J Arthroplasty. 2023. PMID: 36708935
-
Tantalum Components in Difficult Acetabular Revisions Have Good Survival at 5 to 10 Years: Longer Term Followup of a Previous Report.Clin Orthop Relat Res. 2018 Feb;476(2):336-342. doi: 10.1007/s11999.0000000000000005. Clin Orthop Relat Res. 2018. PMID: 29529665 Free PMC article.
-
Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA With Severe Bone Defects.Clin Orthop Relat Res. 2016 Mar;474(3):731-40. doi: 10.1007/s11999-015-4587-0. Epub 2015 Oct 14. Clin Orthop Relat Res. 2016. PMID: 26467611 Free PMC article.
-
Acetabular distraction: an alternative approach to pelvic discontinuity in failed total hip replacement.Bone Joint J. 2014 Nov;96-B(11 Supple A):73-7. doi: 10.1302/0301-620X.96B11.34316. Bone Joint J. 2014. PMID: 25381413 Review.
Cited by
-
Management of acetabular bone loss in revision total hip replacement: a narrative literature review.Ann Jt. 2023 Oct 5;9:21. doi: 10.21037/aoj-23-23. eCollection 2024. Ann Jt. 2023. PMID: 38694811 Free PMC article. Review.
-
A review of the design, manufacture, and outcomes of custom total joint replacement implants available in the United States.J Clin Orthop Trauma. 2024 Feb 1;49:102354. doi: 10.1016/j.jcot.2024.102354. eCollection 2024 Feb. J Clin Orthop Trauma. 2024. PMID: 38361508 Review.
-
The Use of Calcium Sulfate/Hydroxyapatite Bone Graft Substitute to Restore Acetabular Bone Loss in Revision Total Hip Arthroplasty.Arthroplast Today. 2023 Sep 18;23:101217. doi: 10.1016/j.artd.2023.101217. eCollection 2023 Oct. Arthroplast Today. 2023. PMID: 37745956 Free PMC article.
-
Custom triflange acetabular components for large acetabular defect reconstruction in revision total hip arthroplasty: a systematic review and meta-analysis on 1218 patients.EFORT Open Rev. 2023 Jul 3;8(7):522-531. doi: 10.1530/EOR-22-0081. EFORT Open Rev. 2023. PMID: 37395708 Free PMC article.
-
The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes.Hip Pelvis. 2023 Jun;35(2):122-132. doi: 10.5371/hp.2023.35.2.122. Epub 2023 Jun 2. Hip Pelvis. 2023. PMID: 37323551 Free PMC article.
References
-
- Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1692–1702. - PubMed
-
- Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;74:711–715. - PubMed
-
- Chen WM, Engh CA, Jr, Hopper RH, Jr, McAuley JP, Engh CA. Acetabular revision with use of a bilobed component inserted without cement in patients who have acetabular bone-stock deficiency. J Bone Joint Surg Am. 2000;82:197–206. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials