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Published in: Archives of Orthopaedic and Trauma Surgery 5/2009

01-05-2009 | Orthopaedic Surgery

Revision of failed acetabular components utilizing a cementless oblong cup: an average 9-year follow-up study

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2009

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Abstract

Introduction

Failure of acetabular components often leads to bone loss with extensive elongated defects in the surrounding bone. In these cases, reconstruction is challenging and stable fixation of the revision implant difficult. The use of an oblong cup has been described as an option for acetabular reconstruction in such revisions. We report the first long-term results obtained with this implant to date.

Materials and methods

Fifty-six longitudinal oblong revision cups (LOR™) were evaluated clinically and radiologically after a follow-up of 8–12 years (average 9 years). The defects treated with the LOR™ cup ranged from Paprosky type 1–3. Allogenic cancellous bone chips were additionally used in 31 reconstructions to fill cavitary defects.

Results

Based on radiological criteria, 50 acetabular implants underwent osseointegration without any definitive signs of loosening; 2 consistently exhibited zonal radiolucent lines that were always smaller than 2 mm, 1 migrated by around 3 mm. None of these cases exhibited any clinical symptoms. In 11 cases where acetabular defects manifested postoperatively, 8 were remodeled completely and 3 partially at final follow-up. Three revision implants migrated farther than 5 mm and had to be revised before 32-month follow-up. In addition, 1 septic implant failure occurred. After an average follow-up of 9 years, 93% of the investigated implants remained in situ without further revision and 95% without aseptic implant failure.

Conclusion

This 12-year clinical study demonstrates that the LOR™ cup offers a successful concept for the revision of failed acetabular components that also promotes the biological reconstruction of bony defects. Compared with other methods with similarly long follow-ups, our long-term results prove this procedure has a very low rate of revision and aseptic implant failure.
Literature
1.
go back to reference Aebi M, Richner L, Ganz R (1989) Long-term results of primary hip total prosthesis with acetabulum reinforcement ring. Orthopade 18:504–510PubMed Aebi M, Richner L, Ganz R (1989) Long-term results of primary hip total prosthesis with acetabulum reinforcement ring. Orthopade 18:504–510PubMed
2.
go back to reference Berry DJ, Sutherland CJ, Trousdale RT, Colwell CW Jr, Chandler HP, Ayres D, Yashar AA (2000) Bilobed oblong porous coated acetabular components in revision total hip arthroplast. Clin Orthop 371:154–160PubMedCrossRef Berry DJ, Sutherland CJ, Trousdale RT, Colwell CW Jr, Chandler HP, Ayres D, Yashar AA (2000) Bilobed oblong porous coated acetabular components in revision total hip arthroplast. Clin Orthop 371:154–160PubMedCrossRef
3.
go back to reference Bradford MS, Paprosky WG (1995) Total acetabular transplant allograft reconstruction of the severely deficient acetabulum. Semin Arthroplasty 6:86–95PubMed Bradford MS, Paprosky WG (1995) Total acetabular transplant allograft reconstruction of the severely deficient acetabulum. Semin Arthroplasty 6:86–95PubMed
4.
go back to reference Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg 67A:1074–1085 Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD, Ranawat CS (1985) Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg 67A:1074–1085
5.
go back to reference Civinini R, Capone A, Carulli C, Villano M, Gusso MI (2007) Acetabular revisions using a cementless oblong cup: five to ten year results. Int Orthop 32(2):189–193PubMedCrossRef Civinini R, Capone A, Carulli C, Villano M, Gusso MI (2007) Acetabular revisions using a cementless oblong cup: five to ten year results. Int Orthop 32(2):189–193PubMedCrossRef
6.
go back to reference Convery FR, Minteer-Convery M, Devine SD, Meyers MH (1990) Acetabular augmentation in primary and revision total hip arthroplasty with cementless prostheses. Clin Orthop 252:167–175PubMed Convery FR, Minteer-Convery M, Devine SD, Meyers MH (1990) Acetabular augmentation in primary and revision total hip arthroplasty with cementless prostheses. Clin Orthop 252:167–175PubMed
7.
go back to reference Dearborn JT, Harris WH (1999) High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg 81A:469–480 Dearborn JT, Harris WH (1999) High placement of an acetabular component inserted without cement in a revision total hip arthroplasty. Results after a mean of ten years. J Bone Joint Surg 81A:469–480
8.
go back to reference Dearborn JT, Harris WH (2000) Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. J Arthroplasty 15:8–15PubMedCrossRef Dearborn JT, Harris WH (2000) Acetabular revision arthroplasty using so-called jumbo cementless components: an average 7-year follow-up study. J Arthroplasty 15:8–15PubMedCrossRef
9.
go back to reference DeBoer DK, Christie MJ (1998) Reconstruction of the deficient acetabulum with an oblong prosthesis: three- to seven-year results. J Arthroplasty 13:674–680PubMedCrossRef DeBoer DK, Christie MJ (1998) Reconstruction of the deficient acetabulum with an oblong prosthesis: three- to seven-year results. J Arthroplasty 13:674–680PubMedCrossRef
10.
go back to reference DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32PubMed DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32PubMed
11.
go back to reference Dorr LD, Wan Z (1995) Ten years of experience with porous acetabular components for revision surgery. Clin Orthop 319:191–200PubMed Dorr LD, Wan Z (1995) Ten years of experience with porous acetabular components for revision surgery. Clin Orthop 319:191–200PubMed
12.
go back to reference Elke R, Berli B, Wagner A, Morscher EW (2003) Acetabular revision in total hip replacement with a press-fit cup. J Bone Joint Surg 85B:1114–1119CrossRef Elke R, Berli B, Wagner A, Morscher EW (2003) Acetabular revision in total hip replacement with a press-fit cup. J Bone Joint Surg 85B:1114–1119CrossRef
13.
go back to reference Engelbrecht DJ, Weber FA, Sweet MBE, Jakim I (1990) Long term results of revision total hip arthroplasty. J Bone Joint Surg 72B:41–45 Engelbrecht DJ, Weber FA, Sweet MBE, Jakim I (1990) Long term results of revision total hip arthroplasty. J Bone Joint Surg 72B:41–45
14.
go back to reference Engh CA, Glassmann AH, Griffin WL, Mayer JG (1988) Cementless revision for failed cemented total hip arthroplasty. Clin Orthop 235:91–110PubMed Engh CA, Glassmann AH, Griffin WL, Mayer JG (1988) Cementless revision for failed cemented total hip arthroplasty. Clin Orthop 235:91–110PubMed
15.
go back to reference Garbuz D, Morsi E, Gross AE (1996) Revision of the acetabular component of total hip arthroplasty with a massive structural allograft. J Bone Joint Surg 78A:693–697 Garbuz D, Morsi E, Gross AE (1996) Revision of the acetabular component of total hip arthroplasty with a massive structural allograft. J Bone Joint Surg 78A:693–697
16.
go back to reference Gerber A, Pisan M, Zurakowski D, Isler B (2003) Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty. J Bone Joint Surg 85A:2358–2364 Gerber A, Pisan M, Zurakowski D, Isler B (2003) Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty. J Bone Joint Surg 85A:2358–2364
17.
go back to reference Gill TJ, Sledge JB, Müller ME (1998) The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg 80B:946–953CrossRef Gill TJ, Sledge JB, Müller ME (1998) The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg 80B:946–953CrossRef
18.
go back to reference Götze C, Sippel C, Wendt G, Steinbeck J (2003) Limits in cementless hip revision total hip arthroplasty. Z Orthop Ihre Grenzgeb 141:182–189PubMedCrossRef Götze C, Sippel C, Wendt G, Steinbeck J (2003) Limits in cementless hip revision total hip arthroplasty. Z Orthop Ihre Grenzgeb 141:182–189PubMedCrossRef
19.
go back to reference Gurtner P, Aebi M, Ganz R (1993) The M.E. Müller acetabular roof reinforcement ring in revision arthroplasty of the hip. Z Orthop Ihre Grenzgeb 131:594–600PubMedCrossRef Gurtner P, Aebi M, Ganz R (1993) The M.E. Müller acetabular roof reinforcement ring in revision arthroplasty of the hip. Z Orthop Ihre Grenzgeb 131:594–600PubMedCrossRef
20.
go back to reference Herrera A, Martinez AA, Cuenca J, Canales V (2006) Management of types III and IV acetabular deficiencies with the longitudinal oblong revision cup. J Arthroplasty 21(6):857–864PubMedCrossRef Herrera A, Martinez AA, Cuenca J, Canales V (2006) Management of types III and IV acetabular deficiencies with the longitudinal oblong revision cup. J Arthroplasty 21(6):857–864PubMedCrossRef
21.
go back to reference Herzog R, Morscher E (1994) Morselized homologous grafts in revision arthroplasty of the acetabulum. Chir Organi Mov 79:371–378PubMed Herzog R, Morscher E (1994) Morselized homologous grafts in revision arthroplasty of the acetabulum. Chir Organi Mov 79:371–378PubMed
22.
go back to reference Hoikka V, Schlenzka D, Wirta J, Paavilainen T, Eskola A, Santavirta S, Lindholm TS (1993) Failures after revision hip arthroplasties with threaded cups and structural bone allografts. Loosening of 13/18 cases after 1–4 years. Acta Orthop Scand 64:403–407PubMedCrossRef Hoikka V, Schlenzka D, Wirta J, Paavilainen T, Eskola A, Santavirta S, Lindholm TS (1993) Failures after revision hip arthroplasties with threaded cups and structural bone allografts. Loosening of 13/18 cases after 1–4 years. Acta Orthop Scand 64:403–407PubMedCrossRef
23.
go back to reference Hooten JP Jr, Engh CA Jr, Engh CA (1994) Failure of structural acetabular allografts in cementless revision hip arthroplasty. J Bone Joint Surg 76B:419–122 Hooten JP Jr, Engh CA Jr, Engh CA (1994) Failure of structural acetabular allografts in cementless revision hip arthroplasty. J Bone Joint Surg 76B:419–122
24.
go back to reference Jasty M, Harris WH (1988) Results of total hip reconstruction using acetabular mesh in patients with central acetabular deficiency. Clin Orthop 237:142–149PubMed Jasty M, Harris WH (1988) Results of total hip reconstruction using acetabular mesh in patients with central acetabular deficiency. Clin Orthop 237:142–149PubMed
25.
go back to reference Jasty M, Harris WH (1990) Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts. J Bone Joint Surg 72B:63–71 Jasty M, Harris WH (1990) Salvage total hip reconstruction in patients with major acetabular bone deficiency using structural femoral head allografts. J Bone Joint Surg 72B:63–71
26.
go back to reference Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Müller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement: a standard system of terminology for reporting results. J Bone Joint Surg 72A:161–168 Johnston RC, Fitzgerald RH Jr, Harris WH, Poss R, Müller ME, Sledge CB (1990) Clinical and radiographic evaluation of total hip replacement: a standard system of terminology for reporting results. J Bone Joint Surg 72A:161–168
27.
go back to reference Kavanagh BF, Fitzgerald RH (1987) Multiple revisions for failed total hip arthroplasty not associated with infection. J Bone Joint Surg 69A:1144–1149 Kavanagh BF, Fitzgerald RH (1987) Multiple revisions for failed total hip arthroplasty not associated with infection. J Bone Joint Surg 69A:1144–1149
28.
go back to reference Köster G, Willert HG, Köhler HP, Döpkens K (1998) An oblong revision cup for large acetabular defects: design rationale and two- to seven-year follow-up. J Arthroplasty 13:559–569PubMedCrossRef Köster G, Willert HG, Köhler HP, Döpkens K (1998) An oblong revision cup for large acetabular defects: design rationale and two- to seven-year follow-up. J Arthroplasty 13:559–569PubMedCrossRef
29.
go back to reference Kwong LM, Jasty M, Harris WH (1993) High failure rate of bulk femoral head allografts in total hip acetabular reconstructions at 10 years. J Arthroplasty 8:341–346PubMedCrossRef Kwong LM, Jasty M, Harris WH (1993) High failure rate of bulk femoral head allografts in total hip acetabular reconstructions at 10 years. J Arthroplasty 8:341–346PubMedCrossRef
30.
go back to reference Lachiewicz PF, Hussamy OD (1994) Revision of the acetabulum without cement with use of the Harris Galante porous-coated implant. Two to eight-year results. J Bone Joint Surg 76A:1834–1839 Lachiewicz PF, Hussamy OD (1994) Revision of the acetabulum without cement with use of the Harris Galante porous-coated implant. Two to eight-year results. J Bone Joint Surg 76A:1834–1839
31.
go back to reference Marti RK, Schüller HM, Besselaar PP, Haasnoot ELV (1990) Results of revision of hip arthroplasty with cement. J Bone Joint Surg 72A:346–354 Marti RK, Schüller HM, Besselaar PP, Haasnoot ELV (1990) Results of revision of hip arthroplasty with cement. J Bone Joint Surg 72A:346–354
32.
go back to reference McGann WA, Welch RB, Picetti GD (1988) Acetabular preparation in cementless revision total hip arthroplasty. Clin Orthop 235:35–46PubMed McGann WA, Welch RB, Picetti GD (1988) Acetabular preparation in cementless revision total hip arthroplasty. Clin Orthop 235:35–46PubMed
33.
go back to reference Morscher E, Dick W, Seelig W (1989) Revisions-Arthroplastik des Hüftgelenks mit autologer und homologer Spongiosa. Orthopäde 18:428–437PubMed Morscher E, Dick W, Seelig W (1989) Revisions-Arthroplastik des Hüftgelenks mit autologer und homologer Spongiosa. Orthopäde 18:428–437PubMed
34.
go back to reference Morsi E, Garbuz D, Gross AE (1994) Revision total hip arthroplasty with shelf bulk allografts. A long-term follow-up study. J Arthroplasty 11:86–90CrossRef Morsi E, Garbuz D, Gross AE (1994) Revision total hip arthroplasty with shelf bulk allografts. A long-term follow-up study. J Arthroplasty 11:86–90CrossRef
35.
go back to reference Mulroy RD, Harris WH (1990) Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence a follow-up note. J Bone Joint Surg 72A:1536–1540 Mulroy RD, Harris WH (1990) Failure of acetabular autogenous grafts in total hip arthroplasty. Increasing incidence a follow-up note. J Bone Joint Surg 72A:1536–1540
36.
go back to reference Nunn D, Freeman MAR, Hill PF, Evans SJW (1989) The measurement of migration of the acetabular component of hip prostheses. J Bone Joint Surg 71B:629–631 Nunn D, Freeman MAR, Hill PF, Evans SJW (1989) The measurement of migration of the acetabular component of hip prostheses. J Bone Joint Surg 71B:629–631
37.
go back to reference Oh I, Harris WH (1982) Design concepts, indications, and surgical technique for use of the protrusio shell. Clin Orthop 162:175–184PubMed Oh I, Harris WH (1982) Design concepts, indications, and surgical technique for use of the protrusio shell. Clin Orthop 162:175–184PubMed
38.
go back to reference Padgett DE, Kull L, Rosenberg A, Sumner DR, Galante JO (1993) Revision of the acetabular component without cement after total hip arthroplasty. J Bone Joint Surg 75A:663–673 Padgett DE, Kull L, Rosenberg A, Sumner DR, Galante JO (1993) Revision of the acetabular component without cement after total hip arthroplasty. J Bone Joint Surg 75A:663–673
39.
go back to reference Paprosky WG, Magnus RE (1994) Principles of bone grafting in revision total hip arthroplasty. Acetabular technique. Clin Orthop 298:147–155PubMed Paprosky WG, Magnus RE (1994) Principles of bone grafting in revision total hip arthroplasty. Acetabular technique. Clin Orthop 298:147–155PubMed
40.
go back to reference Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9:33PubMedCrossRef Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 9:33PubMedCrossRef
41.
go back to reference Pellicci PM, Wilson PD, Sledge CB, Salvati EA, Ranawat CS, Poss R, Callaghan JJ (1985) Long-term results of revision total hip replacement. J Bone Joint Surg 67A:513–516 Pellicci PM, Wilson PD, Sledge CB, Salvati EA, Ranawat CS, Poss R, Callaghan JJ (1985) Long-term results of revision total hip replacement. J Bone Joint Surg 67A:513–516
42.
go back to reference Perka C, Ludwig R (2001) Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage. J Arthroplasty 16:568–574PubMedCrossRef Perka C, Ludwig R (2001) Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage. J Arthroplasty 16:568–574PubMedCrossRef
43.
go back to reference Pollock FH, Whiteside LA (1992) The fate of massive allografts in total hip acetabular revision surgery. J Arthroplasty 7(3):271–276PubMedCrossRef Pollock FH, Whiteside LA (1992) The fate of massive allografts in total hip acetabular revision surgery. J Arthroplasty 7(3):271–276PubMedCrossRef
44.
go back to reference Silverton CD, Rosenberg AG, Sheinkop MB, Kull LR, Galante JO (1995) Revision total hip arthroplasty using a cementless acetabular component. Technique and results. Clin Orthop 319:201–208PubMed Silverton CD, Rosenberg AG, Sheinkop MB, Kull LR, Galante JO (1995) Revision total hip arthroplasty using a cementless acetabular component. Technique and results. Clin Orthop 319:201–208PubMed
45.
go back to reference Stiehl JB (1995) Extensile anterior column acetabular reconstruction in revision total hip arthroplasty. Semin Arthroplasty 6:60–67PubMed Stiehl JB (1995) Extensile anterior column acetabular reconstruction in revision total hip arthroplasty. Semin Arthroplasty 6:60–67PubMed
46.
go back to reference Strömberg CN, Herberts P (1994) A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report. J Arthroplasty 9(6):595–601PubMedCrossRef Strömberg CN, Herberts P (1994) A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old. A follow-up report. J Arthroplasty 9(6):595–601PubMedCrossRef
47.
go back to reference Surace MF, Zatti G, De Pietri M, Cherubino P (2006) Acetabular revision surgery with the LOR cup 3 to 8 years’ follow-up. J Arthroplasty 21(1):114–121PubMedCrossRef Surace MF, Zatti G, De Pietri M, Cherubino P (2006) Acetabular revision surgery with the LOR cup 3 to 8 years’ follow-up. J Arthroplasty 21(1):114–121PubMedCrossRef
48.
go back to reference Sutherland CJ (1996) Early experience with eccentric acetabular components in revision total hip arthroplasty. Am J Orthop 25:284–289PubMed Sutherland CJ (1996) Early experience with eccentric acetabular components in revision total hip arthroplasty. Am J Orthop 25:284–289PubMed
49.
go back to reference Tanzer M, Drucker D, Jasty M, McDonald M, Harris WH (1992) Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg 74A:987–994 Tanzer M, Drucker D, Jasty M, McDonald M, Harris WH (1992) Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg 74A:987–994
50.
go back to reference Zehnter M, Ganz R (1994) Midterm results (5.5–10 years) of acetabular allograft reconstruction with the acetabular ring during total hip revision. J Arthroplasty 9:469–479CrossRef Zehnter M, Ganz R (1994) Midterm results (5.5–10 years) of acetabular allograft reconstruction with the acetabular ring during total hip revision. J Arthroplasty 9:469–479CrossRef
Metadata
Title
Revision of failed acetabular components utilizing a cementless oblong cup: an average 9-year follow-up study
Publication date
01-05-2009
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 5/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-008-0624-8

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