Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Revision Arthroplasty of the Acetabulum in Association with Loss of Bone Stock*† (original) (raw)
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Treatment options and allograft use in revision total hip arthroplasty: the acetabulum
2007
One of the most challenging aspects of revision total hip arthroplasty is management of bone loss. The acetabulum is particularly difficult, with its complex morphology and proximity to major neurovascular structures. We present a reliable classification system of pelvic and acetabular bone loss based on preoperative radiographs, and this classification system directs treatment of bone loss. The type and application of allograft bone required for the reconstruction will be reviewed for each level of bone loss. Good ability to prognosticate each level of treatment is available from follow-up studies based on survival. We know of no other scientifically developed and validated classification of pelvic bone loss that predicts the likely success of the applied treatment.
Outcomes of Isolated Acetabular Revision
Clinical Orthopaedics and Related Research®, 2010
Isolated acetabular revision can be associated with variable patient outcomes; there is a risk of hip instability. We evaluated 42 isolated acetabular revision operations and investigated the impact of patient age, diagnosis, bone stock, bone loss, bone augmentation, and obesity on pain and the Harris hip score. Preoperative radiographs were graded according to Paprosky et al. Postoperative radiographs were graded according to Moore et al. and for implant position, prosthetic fixation, and osteolysis. Complications, patient outcome, reoperations, and acetabular rerevisions were recorded. All patients had complete clinical and radiographic followup with a minimum followup of 2 years (mean, 6.4 years; range, 2-13 years). The mean pain score and the mean Harris hip score improved postoperatively. There was one infection 6 months after operation. There were no dislocations. There were three acetabular rerevisions (7%) for aseptic loosening. Patient age, preoperative diagnosis, bone loss, and pelvic bone augmentation had no influence on pain or Harris hip scores. Before operation, obese patients tended to have less pain than nonobese patients but at followup obese patients had less improvement in pain scores than nonobese patients. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. The senior author (WLH) has a consulting agreement and a product development agreement with DePuy Orthopaedics, Inc, Warsaw, IN. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone...
A stemmed acetabular component in the management of severe acetabular deficiency
The Journal of Bone and Joint Surgery. British volume, 2005
We evaluated the use of a stemmed acetabular component in the treatment of severe acetabular deficiency during revision and complex primary total hip arthroplasty. There were 31 hips of which 24 were revisions (20 for aseptic loosening, four for infection) and the remainder were complex primary arthroplasties. At a mean follow-up of 10.7 years (6 to 12.8), no component had been revised for aseptic loosening; one patient had undergone a revision of the polyethylene liner for wear. There was one failure because of infection. At the latest follow-up, the cumulative survival rate for aseptic loosening, with revision being the end-point, was 100%; for radiographic loosening it was 92% and for infection and radiographic loosening it was 88%. These results justify the continued use of this stemmed component for the reconstruction of severe acetabular deficiency.
Clinical and radiological results over the medium term of isolated acetabular revision
TheScientificWorldJournal, 2014
Acetabular cup loosening is associated with pain, reduced function, and instability of the implant. If such event happens while the femoral implant is in a satisfactory position and is well fixed to the bone, isolated acetabular revision surgery is indicated. The aim of this single-center retrospective study was to evaluate the clinical and radiological results over the medium term (12-month follow-up mean 36, max 60) of isolated acetabular revisions surgery using a porous hemispheric revision shell matched with a cemented all-poly cup and large diameter femoral head (>32). 33 patients were enrolled. We collect any relevant data from the clinical board. Routine clinical and radiographic examinations were performed preoperatively; the postoperative follow-up was made at 1, 3, and 6 months and yearly thereafter. At the last available follow-up, we report satisfactory improvement of functional scores in all the patients; 2 patients (6.1%) showed thigh pain and only 4 hips (12.11%) p...