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Medial acetabular wall breach in total hip arthroplasty – is full-weight-bearing possible? - 22/08/18

Doi : 10.1016/j.otsr.2018.04.020 
Filippo Mandelli, Simon Tiziani, Jürgen Schmitt, Clément M.L. Werner, Hans-Peter Simmen, Georg Osterhoff
 Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland 

Corresponding author.

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Abstract

Background

A breach of the medial acetabular wall is a phenomenon seen frequently due to over-reaming during total hip arthroplasty (THA). The consequences of this issue are not fully understood particularly in cementless THA. A retrospective study was performed to answer whether: immediate postoperative full-weight-bearing in the presence of a medial acetabular wall breach after THA results in more short-term revisions of the acetabular component, and increases the risk for migration of the acetabular component?

Hypothesis

Immediate full-weight-bearing in the presence of a medial breach is not associated with an increased likelihood for acetabular-related revision surgery or migration of the cup.

Patients and methods

In this retrospective cohort study, consecutive patients (n=95; mean age 68±13 years; 67 female) who underwent THA with an uncemented acetabular component were identified and a retrospective chart review was performed (follow-up 23±17 months, range 6 to 79 months). The presence of a postoperative radiographic medial acetabular breach was documented and the need for revision surgery and the rate of acetabular component migration were assessed during follow-up.

Results

Some extent of radiographic medial acetabular wall breach was seen in 26/95 patients (27%). With regard to the primary outcome, 2/95 patients (2%) required revision surgery during follow-up. All revision surgeries occurred in the group without a medial breach (p=0.280) for causes related to the femoral or the head components. Persistent pain was present in 1/26 patients (3.8%) in the medial breach group and 8/69 patients in the control group (11.6%; p=0.436). In the radiographic follow-up (n=81), there was no significant difference between the control group and the medial breach group with regard to cup migration (Δ ilio-ischial overlap [distance between the ilio-ischial line and a parallel line tangential to the acetabular cup on AP views]: −0.5±0.9mm [range, −2.9 to 0.8] vs. −0.3±1.7mm [range, −1.9 to 2.2], Δ overlap tangent [defined as the distance between the two crossings of ilio-ischial line and the acetabular component on AP views]: −2.2±6.1mm [range, −21.4 to 0.0] vs. 0.4±6.9mm [range, −6.2 to 17.6]). Similarly, according to variation in the ilio-ischial overlap distance between postoperative and follow-up on pelvic AP views, 0/56 hips (0%) had cup migration ≥ 5mm in the control group versus 1/25 (4%) in the medial breach cohort (p=0.3).

Discussion

In this retrospective observation of patients with immediate postoperative full-weight-bearing after THA, a radiographic breach of the medial acetabular wall was not associated with an increased risk for short-term revision surgery or radiographic migration at follow-up. According to the findings of this study and in the light of previous biomechanical studies, there is no clear evidence for postoperative partial weight-bearing in case of a medial breach as far as the surgeon feels that the acetabular component is stable.

Level of Evidence

IV, Retrospective cohort study.

El texto completo de este artículo está disponible en PDF.

Keywords : Acetabular component, Bone defect, Medial breach, Partial weight-bearing, Total hip arthroplasty, Total hip replacement


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Vol 104 - N° 5

P. 675-679 - septembre 2018 Regresar al número
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