[Exchange of Acetabular Cups with Severe Bone Defects Using Antiprotrusion Cages]

Overview

Journal Oper Orthop Traumatol

Publisher Springer

Specialties Emergency Medicine
Orthopedics

Date 2010 Aug 3

PMID 20676820

Citations 4

Authors

Bernd Fink

Alexandra Grossmann

Pavel Sebena

Affiliations

Soon will be listed here.

Abstract

Objective: Replacement of a loosened acetabular cup attended by massive bone defects involving both columns. Acetabular restoration and proof fixation of a new acetabular cup to restore a pain-free joint function.

Indications: Segmental acetabular bone defects involving both columns (Paprosky type 3A, 3B) with loosened acetabular cup or a Girdlestone situation. In case of pelvic discontinuity (Paprosky type 4) combination with reconstructive osteosynthesis plates (for example, Synthes company, Bochum, Germany).

Contraindications: In cases of complete absence of the posterior and especially cranioposterior column combination with structural allograft reconstruction necessary. Relative: acetabular defects, that can be reconstructed by other, smaller implants, for example, press-fit acetabular cups.

Surgical Technique: Exposure of the acetabulum by a conventional approach. Removal of the loosened acetabular cup. Cleaning of the acetabulum with a sharp spoon. Rebuilding of the hip center with a reamer. Choice of the size of the antiprotrusion ring using trial implants. Access chiseling for the inferior implant flange into the ischium. If necessary, adaptation of the superior and inferior flange alignment to the individual anatomy by bending. Filling of bone defects with allogenic bone chips. Knocking in of the inferior flange into the ischium. Simultaneous knocking in of both the ring in the acetabulum and the superior flange at the ischium. Screwing in of bolts from the interior of the ring into the iliac bone in the direction of hip forces. Additional positioning of screws due to the superior flange into the iliac bone. Cementing in of a polyethylene cup in the antiprotrusion ring.

Postoperative Management: Antithrombotic prophylaxis, physical therapy, gait training under full weight bearing of the limb.

Results: 30 acetabular cup revisions with a new Burch-Schneider ring underwent prospective clinical and radiologic examination and were analyzed for an average follow-up of 20.6+/-7.8 months (3-36 months). The Harris Hip Score increased from preoperative 46.6 to postoperative 75.9 points. A loosening of the cage was not recorded.

Citing Articles

Use of morselized bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis.

Cimatti P, Del Piccolo N, Dallari B, Mazzotta A, Dallari D J Exp Orthop. 2024; 11(4):e70091.

PMID: 39634575 PMC: 11615971. DOI: 10.1002/jeo2.70091.

The augment-and-modular-cage revision system for reconstruction of severe acetabular defects-two-year clinical and radiographic results.

Roessler P, Jaenisch M, Kuhlmann M, Wacker M, Johannes Wagenhauser P, Gravius S Int Orthop. 2018; 43(10):2269-2278.

PMID: 30539219 DOI: 10.1007/s00264-018-4271-6.

[Periprosthetic bone defects of the hip joint].

Wirtz D Oper Orthop Traumatol. 2014; 26(2):112-3.

PMID: 24687520 DOI: 10.1007/s00064-014-0298-z.

[Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments : the cage-and-augment system].

Gunther K, Wegner T, Kirschner S, Hartmann A Oper Orthop Traumatol. 2014; 26(2):141-55.

PMID: 24687519 DOI: 10.1007/s00064-013-0271-2.

References

van Koeveringe A, Ochsner P . Revision cup arthroplasty using Burch-Schneider anti-protrusio cage. Int Orthop. 2002; 26(5):291-5. PMC: 3621000. DOI: 10.1007/s00264-002-0361-5. View

Gill T, Sledge J, Muller M . The Bürch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results. J Bone Joint Surg Br. 1998; 80(6):946-53. DOI: 10.1302/0301-620x.80b6.8658. View

Starker M, Kandziora F, Jager A, Kerschbaumer F . [Acetabular reconstruction using acetabular reinforcement rings]. Orthopade. 1998; 27(6):366-74. DOI: 10.1007/pl00003508. View

Winter E, Piert M, Volkmann R, Maurer F, Eingartner C, Weise K . Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am. 2001; 83(6):862-7. DOI: 10.2106/00004623-200106000-00007. View

Symeonides P, Petsatodes G, Pournaras J, Kapetanos G, Christodoulou A, Papadopoulos P . Replacement of deficient acetabulum using Burch-Schneider cages. 22 patients followed for 2-10 years. Acta Orthop Scand Suppl. 1997; 275:30-2. DOI: 10.1080/17453674.1997.11744739. View

Schatzker J, Glynn M, Ritter D . A preliminary review of the Müller acetabular and Burch-Schneider antiprotrusio support rings. Arch Orthop Trauma Surg (1978). 1984; 103(1):5-12. DOI: 10.1007/BF00451312. View

Bohm P, Banzhaf S . Acetabular revision with allograft bone. 103 revisions with 3 reconstruction alternatives, followed for 0.3-13 years. Acta Orthop Scand. 1999; 70(3):240-9. DOI: 10.3109/17453679908997800. View

Berry D, Sutherland C, Trousdale R, Colwell Jr C, CHANDLER H, Ayres D . Bilobed oblong porous coated acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res. 2000; (371):154-60. DOI: 10.1097/00003086-200002000-00019. View

Rosson J, Schatzker J . The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br. 1992; 74(5):716-20. DOI: 10.1302/0301-620X.74B5.1527120. View

10.

Perka C, Ludwig R . Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage. J Arthroplasty. 2001; 16(5):568-74. DOI: 10.1054/arth.2001.23919. View

11.

Bonnomet F, Clavert P, Gicquel P, Lefebvre Y, Kempf J . [Reconstruction by graft and reinforcement device in severe aseptic acetabular loosening: 10 years survivorship analysis]. Rev Chir Orthop Reparatrice Appar Mot. 2001; 87(2):135-46. View

12.

Udomkiat P, Dorr L, Won Y, Longjohn D, Wan Z . Technical factors for success with metal ring acetabular reconstruction. J Arthroplasty. 2001; 16(8):961-9. DOI: 10.1054/arth.2001.27669. View

13.

Paprosky W, Perona P, Lawrence J . Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994; 9(1):33-44. DOI: 10.1016/0883-5403(94)90135-x. View

14.

Blacha J, Gagala J . The Burch-Schneider antiprotrusio cage in revision hip arthroplasty with acetabular bone defect. Ortop Traumatol Rehabil. 2007; 6(5):631-7. View

15.

Zehntner M, Ganz R . Midterm results (5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision. J Arthroplasty. 1994; 9(5):469-79. DOI: 10.1016/0883-5403(94)90092-2. View

16.

Fink B, Grossmann A . Modified transfemoral approach to revision arthroplasty with uncemented modular revision stems. Oper Orthop Traumatol. 2007; 19(1):32-55. DOI: 10.1007/s00064-007-1194-6. View

17.

Wachtl S, Jung M, Jakob R, Gautier E . The Burch-Schneider antiprotrusio cage in acetabular revision surgery: a mean follow-up of 12 years. J Arthroplasty. 2000; 15(8):959-63. DOI: 10.1054/arth.2000.17942. View

18.

Mayer G, Hartseil K . Acetabular reinforcement in total hip replacement. Arch Orthop Trauma Surg (1978). 1986; 105(4):227-31. DOI: 10.1007/BF00435486. View

19.

Garbuz D, Morsi E, Gross A . Revision of the acetabular component of a total hip arthroplasty with a massive structural allograft. Study with a minimum five-year follow-up. J Bone Joint Surg Am. 1996; 78(5):693-7. DOI: 10.2106/00004623-199605000-00008. View