Trabecular metal cup outcomes in complex acetabular reconstruction. Review of 42 cases with a 3-year follow-up.
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Published:
Nov 13, 2018
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Abstract
IntroductionThe aim of this study is to assess our clinical-radiographic results with the use of trabecular tantalum cups for the reconstruction of complex acetabulums, both in primary surgeries and revisions, and compare them with other authors’ similar series.Materials and MethodsWe carried out a retrospective revision of a series of 42 surgeries (29 revisions and 13 primary arthroplasties) in 40 patients between March 2010 and March 2016. The series included 20 females and 20 males who averaged 60 years of age (ranging from 27 to 93). The patients’ average follow-up was of 37 months (ranging from 12 to 84). All the patients were treated with the same type of trabecular metal.ResultsAt average 37-month follow-up survival rates in the acetabular component were of 97.6%. One patient was treated with resection arthroplasty due to persistent infection. Global complication rates were of 12% and the average postoperative Harris Hip Score was of 81.54 (63.25-92.75).ConclusionsAlthough a longer follow-up is required, the use of trabecular metal cups gets promising results in the treatment of complex acetabulums.
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Rodriguez Hoya, D. H., Bidolegui, F., Alonso, R., & Vindver, G. (2018). Trabecular metal cup outcomes in complex acetabular reconstruction. Review of 42 cases with a 3-year follow-up. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(4), 274-282. https://doi.org/10.15417/issn.1852-7434.2018.83.4.791
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Clinical Research
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References
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4. Lugones A, Díaz Gallardo P, Bidolegui F, Vindver G, Allende B. Artroplastia total de cadera con copa no cementada en secuela de fractura de acetábulo. Rev Asoc Argent Ortop Traumatol 2012;77(3):185-91. doi:10.15417/128
5. Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res 2004;420:96-100. doi: 10.1097/00003086-200403000-00013
6. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 1999;81(5):907-14. PMID: 10530861
7. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9(1):33-44. doi: 10.1016/0883-5403(94)90135-X
8. Malkani AL, Price MR, Crawford CH 3rd, Baker DL. Acetabular component revision using a porous tantalum biomaterial: a case series. J Arthroplasty 2009;24(7):1068-73. doi: 10.1016/j.arth.2008.07.008
9. Buttaro M, Ali J, Comba F, Sirio A, Zanotti G, Piccaluga F. Copas de metal trabecular y aloinjertos óseos impactados en defectos acetabulares graves. Resultados a los 2-4 años. Rev Asoc Argent Ortop Traumatol 2014;79(2):82-91. doi:10.15417/298
10. Skyttä ET, Eskelinen A, Paavolainen PO, Remes VM. Early results of 827 trabecular metal revision shells in acetabular revision. J Arthroplasty 2011;26(3):342-5. doi: 10.1016/j.arth.2010.01.106
11. Sternheim A, Backstein D, Kuzyk PR, Goshua G, Berkovich Y, Safir O, et al. Porous metal revision shells for management of contained acetabular bone defects at a mean follow-up of six years: a comparison between up to 50% bleeding host bone contact and more than 50% contact. J Bone Joint Surg Br 2012;94(2):158-62. doi: 10.1302/0301-620X.94B2.27871
12. Fernandez Fairen M, Murcia A, Blanco A, Meroño A, Murcia A Jr, Ballester J. Revision of failed total hip arthroplasty acetabular cups to porous tantalum components: a 5-year follow-up study. J Arthroplasty 2010;25(6):865-72. doi: 10.1016/j.arth.2009.07.027
13. Weeden SH, Schmidt RH. The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplasty 2007;22 (Suppl 2):151-5. doi: 10.1016/j.arth.2007.04.024
14. Lakstein D, Backstein D, Safir O, Kosashvili Y, Gross AE. Trabecular Metal cups for acetabular defects with 50% or less host bone contact. Clin Orthop Relat Res 2009;467(9):2318-24. doi: 10.1007/s11999-009-0772-3
15. Clement RG, Ray AG, MacDonald DJ, Wade FA, Burnett R, Moran M. Trabecular metal use in Paprosky type 2 and 3 acetabular defects: 5-year follow-up. J Arthroplasty 2016;31(4):863-7. doi: 10.1016/j.arth.2015.10.033
16. Issack PS. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 2013;95: 1981-7. doi: 10.2106/JBJS.L.01313
17. Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice computed tomography for evaluating acetabular defects in revision THA. Clin Orthop Relat Res 2007;463:138-43. doi: 10.1097/BLO.0b013e3181566320
18. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55. PMID:5783851
19. Yamasaki S, Masuhara K, Fuji Takeshi. Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. J Bone Joint Surg Am 2005;87:766-70. doi:10.2106/JBJS.D.02046
20. Gomez MM, Tan TL, Manrique J, Deirmengian GK, Parvizi J. The fate of spacers in the treatment of periprosthetic joint infection. J Bone Joint Surg Am 2015;97(18):1495-502. doi: 10.2106/JBJS.N.00958
21. Hofmann AA. Two-stage exchange is better than direct exchange in the infected THA. Orthopedics 1999;22(10):918. PMID:10535552
22. Della Valle C, Parvizi J, Bauer TW, et al. American Academy of Orthopaedic Surgeons. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 2010;18:760-70. PMID: 21119142
23. Levine B, Della Valle CJ, Jacobs JJ. Applications of porous tantalum in total hip arthroplasty. J Am Acad Orthop Surg 2006; 14(12):646-55. PMID: 17077337
24. Sporer S, Paprosky W. The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplasty 2006;21(6 Suppl 2):83-6. doi: 10.1016/j.arth.2006.05.008
25. Kosashvili Y, Backstein D, Safir O, Lakstein D, Gross AE. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg Br 2009;91(7):870-6. doi: 10.1302/0301-620X.91B7.22181
26. Vindver G, Bidolegui F, Di Stefano C. Osteotomía trocantérea extendida para revisiones femorales: indicaciones, técnica y resultados. Evaluación de 100 pacientes con 116 osteotomías. Rev Asoc Argent Ortop Traumatol 2010;75(2):115-24. http://www.aaot.org.ar/revista/2010/n2/Rev_AsocArgentOrtopTraumatol_2010_75_115-124_Vindver.pdf
27. Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty 1989;4:245-51. PMID: 2795031
28. Buttaro MA, de la Rosa DM, Comba F, Piccaluga F. High failure rate with the GAP II ring and impacted allograft bone in severe acetabular defects. Clin Orthop Relat Res 2012;470(11):3148-55. doi: 10.1007/s11999-012-2402-8
29. Van Haaren EH, Heyligers IC, Alexander FG, Wuisman PI. High rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg Br 2007;89:296-300. doi: 10.1302/0301-620X.89B3.18080
30. Beckmann NA, Weiss S, Klotz MC, Gondan M, Jaeger S, Bitsch RG. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 2014;29(1):229-35. doi: 10.1016/j.arth.2013.04.035
31. Van Egmond N, De Kam DC, Gardeniers JW, Schreurs BW. Revisions of extensive acetabular defects with impaction grafting and a cement cup. Clin Orthop Relat Res 2011;469(2):562-73. doi: 10.1007/s11999-010-1618-8
32. DeBoer DK, Christie MJ, Brinson MF, Morrison JC. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 2007;89(4):835-40. doi: 10.2106/JBJS.F.00313
33. Keurentjes JC, Pijls BG, Van Tol FR, Mentink JF, Mes SD, Schoones JW, et al. Which implant should we use for primary total hip replacement? A systematic review and meta-analysis. J Bone Joint Surg Am 2014;96(Suppl 1(E):79-97.
doi: 10.2106/JBJS.N.00397
34. Rees HW, Fung DA, Cerynik DL, Amin NH, Johanson NA. Revision total hip arthroplasty without bone graft of high-grade acetabular defects. J Arthroplasty 2012;27(1):41-7. doi: 10.1016/j.arth.2011.04.004
2. Deirmengian GK, Zmistowski B, O’Neil JT, Hozack WJ. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am 2011;93:1842-52. doi: 10.2106/JBJS.J.01197
3. Boscainos PJ, Kellett CF, Maury AC, Backstein D, Gross AE. Management of periacetabular bone loss in revision hip arthroplasty. Clin Orthop Relat Res 2007;465:159-65. doi:10.1097/BLO.0b013e3181560c6c
4. Lugones A, Díaz Gallardo P, Bidolegui F, Vindver G, Allende B. Artroplastia total de cadera con copa no cementada en secuela de fractura de acetábulo. Rev Asoc Argent Ortop Traumatol 2012;77(3):185-91. doi:10.15417/128
5. Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res 2004;420:96-100. doi: 10.1097/00003086-200403000-00013
6. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 1999;81(5):907-14. PMID: 10530861
7. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9(1):33-44. doi: 10.1016/0883-5403(94)90135-X
8. Malkani AL, Price MR, Crawford CH 3rd, Baker DL. Acetabular component revision using a porous tantalum biomaterial: a case series. J Arthroplasty 2009;24(7):1068-73. doi: 10.1016/j.arth.2008.07.008
9. Buttaro M, Ali J, Comba F, Sirio A, Zanotti G, Piccaluga F. Copas de metal trabecular y aloinjertos óseos impactados en defectos acetabulares graves. Resultados a los 2-4 años. Rev Asoc Argent Ortop Traumatol 2014;79(2):82-91. doi:10.15417/298
10. Skyttä ET, Eskelinen A, Paavolainen PO, Remes VM. Early results of 827 trabecular metal revision shells in acetabular revision. J Arthroplasty 2011;26(3):342-5. doi: 10.1016/j.arth.2010.01.106
11. Sternheim A, Backstein D, Kuzyk PR, Goshua G, Berkovich Y, Safir O, et al. Porous metal revision shells for management of contained acetabular bone defects at a mean follow-up of six years: a comparison between up to 50% bleeding host bone contact and more than 50% contact. J Bone Joint Surg Br 2012;94(2):158-62. doi: 10.1302/0301-620X.94B2.27871
12. Fernandez Fairen M, Murcia A, Blanco A, Meroño A, Murcia A Jr, Ballester J. Revision of failed total hip arthroplasty acetabular cups to porous tantalum components: a 5-year follow-up study. J Arthroplasty 2010;25(6):865-72. doi: 10.1016/j.arth.2009.07.027
13. Weeden SH, Schmidt RH. The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplasty 2007;22 (Suppl 2):151-5. doi: 10.1016/j.arth.2007.04.024
14. Lakstein D, Backstein D, Safir O, Kosashvili Y, Gross AE. Trabecular Metal cups for acetabular defects with 50% or less host bone contact. Clin Orthop Relat Res 2009;467(9):2318-24. doi: 10.1007/s11999-009-0772-3
15. Clement RG, Ray AG, MacDonald DJ, Wade FA, Burnett R, Moran M. Trabecular metal use in Paprosky type 2 and 3 acetabular defects: 5-year follow-up. J Arthroplasty 2016;31(4):863-7. doi: 10.1016/j.arth.2015.10.033
16. Issack PS. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 2013;95: 1981-7. doi: 10.2106/JBJS.L.01313
17. Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice computed tomography for evaluating acetabular defects in revision THA. Clin Orthop Relat Res 2007;463:138-43. doi: 10.1097/BLO.0b013e3181566320
18. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55. PMID:5783851
19. Yamasaki S, Masuhara K, Fuji Takeshi. Tranexamic acid reduces postoperative blood loss in cementless total hip arthroplasty. J Bone Joint Surg Am 2005;87:766-70. doi:10.2106/JBJS.D.02046
20. Gomez MM, Tan TL, Manrique J, Deirmengian GK, Parvizi J. The fate of spacers in the treatment of periprosthetic joint infection. J Bone Joint Surg Am 2015;97(18):1495-502. doi: 10.2106/JBJS.N.00958
21. Hofmann AA. Two-stage exchange is better than direct exchange in the infected THA. Orthopedics 1999;22(10):918. PMID:10535552
22. Della Valle C, Parvizi J, Bauer TW, et al. American Academy of Orthopaedic Surgeons. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 2010;18:760-70. PMID: 21119142
23. Levine B, Della Valle CJ, Jacobs JJ. Applications of porous tantalum in total hip arthroplasty. J Am Acad Orthop Surg 2006; 14(12):646-55. PMID: 17077337
24. Sporer S, Paprosky W. The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplasty 2006;21(6 Suppl 2):83-6. doi: 10.1016/j.arth.2006.05.008
25. Kosashvili Y, Backstein D, Safir O, Lakstein D, Gross AE. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg Br 2009;91(7):870-6. doi: 10.1302/0301-620X.91B7.22181
26. Vindver G, Bidolegui F, Di Stefano C. Osteotomía trocantérea extendida para revisiones femorales: indicaciones, técnica y resultados. Evaluación de 100 pacientes con 116 osteotomías. Rev Asoc Argent Ortop Traumatol 2010;75(2):115-24. http://www.aaot.org.ar/revista/2010/n2/Rev_AsocArgentOrtopTraumatol_2010_75_115-124_Vindver.pdf
27. Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty 1989;4:245-51. PMID: 2795031
28. Buttaro MA, de la Rosa DM, Comba F, Piccaluga F. High failure rate with the GAP II ring and impacted allograft bone in severe acetabular defects. Clin Orthop Relat Res 2012;470(11):3148-55. doi: 10.1007/s11999-012-2402-8
29. Van Haaren EH, Heyligers IC, Alexander FG, Wuisman PI. High rate of failure of impaction grafting in large acetabular defects. J Bone Joint Surg Br 2007;89:296-300. doi: 10.1302/0301-620X.89B3.18080
30. Beckmann NA, Weiss S, Klotz MC, Gondan M, Jaeger S, Bitsch RG. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings. A systematic review. J Arthroplasty 2014;29(1):229-35. doi: 10.1016/j.arth.2013.04.035
31. Van Egmond N, De Kam DC, Gardeniers JW, Schreurs BW. Revisions of extensive acetabular defects with impaction grafting and a cement cup. Clin Orthop Relat Res 2011;469(2):562-73. doi: 10.1007/s11999-010-1618-8
32. DeBoer DK, Christie MJ, Brinson MF, Morrison JC. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 2007;89(4):835-40. doi: 10.2106/JBJS.F.00313
33. Keurentjes JC, Pijls BG, Van Tol FR, Mentink JF, Mes SD, Schoones JW, et al. Which implant should we use for primary total hip replacement? A systematic review and meta-analysis. J Bone Joint Surg Am 2014;96(Suppl 1(E):79-97.
doi: 10.2106/JBJS.N.00397
34. Rees HW, Fung DA, Cerynik DL, Amin NH, Johanson NA. Revision total hip arthroplasty without bone graft of high-grade acetabular defects. J Arthroplasty 2012;27(1):41-7. doi: 10.1016/j.arth.2011.04.004