Introduction The aim of this study was to assess results of different revision techniques for large acetabular defects and the identification of possible predictors of these results. Materials and methods This retrospective study was carried out on 33 consecutive patients (22 females, 11 males) who underwent acetabular revision at our Institution for Paprosky grade II B and III (GIR 3 or 4) acetabular bone defects. The average age at surgery was 67.1 years (range 42–86 years). Burch-Schneider reinforcement cage and cemented cup was used in 25 cases, trabecular metal revision shell in 6 cases, and LOR cup in 2 cases. The mean time between primary and revision procedure was 9.1 years and the mean follow-up was 48 months (range 14–112). The Harris Hip Score (HHS) was obtained before surgery and at the latest follow-up control in all patients. Pain at follow-up was evaluated using a 10-cm Visual Analog Scale (VAS). In 27 patients a follow-up radiographic evaluation was also performed. Determinants of HHS score at follow-up were assessed by linear regression analysis, using age, sex, BMI, rate of co-morbidity (FCI), use of reinforcement ring, and time elapsed from the primary surgery as explanatory variables. Results The average pre-operative and follow-up HHS score was 41 ± 16 and 79 ± 13, respectively (p\0.001). The average pain reported by patients on the VAS scale at follow-up was 3.2 ± 1.7. The overall re-revision rate was of 18 % (6/33 patients). At the multivariate analysis the only negative determinant of the HHS at follow-up was FCI (c = -5.3, p = 0.007). Different surgical options were not associated with differences in the functional outcome. Three Burch-Schneider reinforcement cages showed slight signs of radiographic loosening. The use of trabecular metal components was associated, in most cases, to the presence of newly formed acetabular bone at the follow-up. Discussion Newly formed bone on tantalum components was observed. Co-morbidity is a negative predictor of hip function. Our results are in keeping with previously published data. Conclusions Positive clinical results were detected with both acetabular reinforcement cages and trabecular metal revision shells in severe acetabular defects.

Revision arthroplasty in large acetabular bone defects: results and prognostic predictors

MARICONDA, MASSIMO;COSTA, GIOVAN GIUSEPPE;RECANO, PASQUALE;ORABONA, GIANCLAUDIO;AITANTI, EMANUELE;CERBASI, SIMONE
2013

Abstract

Introduction The aim of this study was to assess results of different revision techniques for large acetabular defects and the identification of possible predictors of these results. Materials and methods This retrospective study was carried out on 33 consecutive patients (22 females, 11 males) who underwent acetabular revision at our Institution for Paprosky grade II B and III (GIR 3 or 4) acetabular bone defects. The average age at surgery was 67.1 years (range 42–86 years). Burch-Schneider reinforcement cage and cemented cup was used in 25 cases, trabecular metal revision shell in 6 cases, and LOR cup in 2 cases. The mean time between primary and revision procedure was 9.1 years and the mean follow-up was 48 months (range 14–112). The Harris Hip Score (HHS) was obtained before surgery and at the latest follow-up control in all patients. Pain at follow-up was evaluated using a 10-cm Visual Analog Scale (VAS). In 27 patients a follow-up radiographic evaluation was also performed. Determinants of HHS score at follow-up were assessed by linear regression analysis, using age, sex, BMI, rate of co-morbidity (FCI), use of reinforcement ring, and time elapsed from the primary surgery as explanatory variables. Results The average pre-operative and follow-up HHS score was 41 ± 16 and 79 ± 13, respectively (p\0.001). The average pain reported by patients on the VAS scale at follow-up was 3.2 ± 1.7. The overall re-revision rate was of 18 % (6/33 patients). At the multivariate analysis the only negative determinant of the HHS at follow-up was FCI (c = -5.3, p = 0.007). Different surgical options were not associated with differences in the functional outcome. Three Burch-Schneider reinforcement cages showed slight signs of radiographic loosening. The use of trabecular metal components was associated, in most cases, to the presence of newly formed acetabular bone at the follow-up. Discussion Newly formed bone on tantalum components was observed. Co-morbidity is a negative predictor of hip function. Our results are in keeping with previously published data. Conclusions Positive clinical results were detected with both acetabular reinforcement cages and trabecular metal revision shells in severe acetabular defects.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11588/640082
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