Stemmed acetabular cup as a salvage implant for revision total hip arthroplasty with Paprosky type IIIA and IIIB acetabular bone loss - 05/04/20
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Abstract |
Introduction |
Certain cases of repeated acetabular loosening with severe bone loss are hardly amenable to reconstruction using a Kerboull-type plate with allograft. This limitation is more likely when the severe bone loss occurs in older adults with significant comorbidities that may require a faster procedure. In these indications, a stemmed acetabular cup may be an alternative, although the outcomes have not been well defined, especially for a version where the peg is coated with porous material and additional screws can be added. This led us to conduct a retrospective study to determine: (1) whether a stemmed cup anchored in the iliac isthmus is a viable alternative in these situations, (2) the complication rate and (3) the revision rate for any reason.
Hypothesis |
A stemmed cup anchored in the iliac isthmus is a viable alternative in cases of repeated revision with severe acetabular bone loss.
Materials and methods |
We performed a retrospective single-center study. Sixteen Integra™ cups were implanted in 14 patients (mean age 72.8±10.4 years, minimum–maximum: 58–95) who had aseptic acetabular loosening combined with severe acetabular bone loss graded as Paprosky IIIA in 7 hips and IIIB in 9 hips. The patients had undergone a mean of 2.7±1.8 (minimum–maximum: 1–6) procedures (i.e. primary and/or revision arthroplasty) before this cup was implanted. The cup's survivorship at the time of review and the complication rate were determined.
Results |
At a mean follow-up of 48.8±23.4 months (minimum–maximum: 7–85), two patients had died and two were lost to follow-up. Six hips experienced one or more complications (37.5%): three infections (18.8%), two mechanical failures (12.5%) and one dislocation (6.7%). The cup had to be removed in three patients (18.8%). These complications required reoperation, thus the cumulative incidence of revision for any reason at 5 years was 31% (95% CI: 11–55%).
Conclusion |
Despite the high complication and revision rates, we believe the stemmed acetabular cup is a viable alternative in salvage reconstruction procedures.
Level of evidence |
IV, Retrospective case study.
Le texte complet de cet article est disponible en PDF.Keywords : Ice cream cone prosthesis, Stemmed acetabular cup, Acetabular loosening, Severe acetabular bone loss, Multiple revisions, Survival, Complications
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