Revision Total Hip Arthroplasty with Medial Wall Defect Using Bone Graft with or Without Porous Metal Restrictor

Overview

Journal Sci Rep

Specialty Science

Date 2024 Nov 9

PMID 39521825

Authors

Min Uk Do

Sang Woo Kang

Sang-Min Lee

Jae Jin Kim

Kuen Tak Suh

Won Chul Shin

Affiliations

Soon will be listed here.

Abstract

When a severe medial wall defect is present in revision total hip arthroplasty (THA), simple bone grafting (BG) may not be sufficient, and trabecular metal (TM) augmentation is often necessary. We aimed to evaluate whether there were differences in outcomes of revision THA with medial wall defects depending on the use of TM augmentation. Between 2009-2021, 130 patients were classified into two groups: 80 patients undergoing bone grafting (BG group) and 50 patients undergoing both bone grafting and TM augmentation (BG/TM group). We evaluated the postoperative center of rotation (COR) position and changes in vertical and horizontal COR at last follow-up. Additionally, we categorized the fate of the transplanted bone graft into four groups: unchanged, initially changed, resorption-no further intervention, and resorption-revision. The mean horizontal COR changes were -3.50 mm in the BG group and -1.07 mm in the BG/TM group (p = 0.005). In the BG/TM group, a higher proportion of the patients showed unchanged or only initial changes when compared to the BG group (88.0% and 65.0%, respectively). The BG/TM group showed more favorable results regarding horizontal changes in the COR and fate of the bone graft. Therefore, for revision THA in patients with severe medial wall defects, the combined use of bone graft and TM augmentation can be a suitable option.

References

Weeden S, Paprosky W . Minimal 11-year follow-up of extensively porous-coated stems in femoral revision total hip arthroplasty. J Arthroplasty. 2002; 17(4 Suppl 1):134-7. DOI: 10.1054/arth.2002.32461. View

Zhou B, Zhou Y, Yang D, Tang H, Shao H, Huang Y . The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study. J Arthroplasty. 2018; 33(12):3724-3733. DOI: 10.1016/j.arth.2018.08.027. View

Jenkins D, Odland A, Sierra R, Hanssen A, Lewallen D . Minimum Five-Year Outcomes with Porous Tantalum Acetabular Cup and Augment Construct in Complex Revision Total Hip Arthroplasty. J Bone Joint Surg Am. 2017; 99(10):e49. DOI: 10.2106/JBJS.16.00125. View

Mahmoud A, Sundberg M, Flivik G . Comparable Results With Porous Metal Augments in Combination With Either Cemented or Uncemented Cups in Revision Hip Arthroplasty: An Analysis of One Hundred Forty-Seven Revisions at a Mean of Five Years. J Arthroplasty. 2017; 32(5):1612-1617. DOI: 10.1016/j.arth.2016.12.007. View

Lochel J, Janz V, Hipfl C, Perka C, Wassilew G . Reconstruction of acetabular defects with porous tantalum shells and augments in revision total hip arthroplasty at ten-year follow-up. Bone Joint J. 2019; 101-B(3):311-316. DOI: 10.1302/0301-620X.101B3.BJJ-2018-0959.R1. View

Bobyn J, Stackpool G, Hacking S, Tanzer M, Krygier J . Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999; 81(5):907-14. DOI: 10.1302/0301-620x.81b5.9283. View

Shin W, Moon N, Jeon S, Suh K . Comparison of Surgical Outcomes Between Standard and Elevated-Rim Highly Cross-Linked Polyethylene Acetabular Liners in Primary Total Hip Arthroplasty With Minimum 15-Year Follow-Up: Single-Center, Retrospective Cohort Study. J Arthroplasty. 2020; 35(5):1290-1296. DOI: 10.1016/j.arth.2019.12.026. View

Bohm P, Bischel O . Femoral revision with the Wagner SL revision stem : evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am. 2001; 83(7):1023-31. View

Weeden S, Schmidt R . The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplasty. 2007; 22(6 Suppl 2):151-5. DOI: 10.1016/j.arth.2007.04.024. View

10.

Eachempati K, Malhotra R, Pichai S, Reddy A, Podhili Subramani A, Gautam D . Results of trabecular metal augments in Paprosky IIIA and IIIB defects: A multicentre study. Bone Joint J. 2018; 100-B(7):903-908. DOI: 10.1302/0301-620X.100B7.BJJ-2017-1604.R1. View

11.

Cruz-Pardos A, Garcia-Rey E, Garcia-Cimbrelo E . Total Hip Arthroplasty with Use of the Cementless Zweymüller Alloclassic System: A Concise Follow-up, at a Minimum of 25 Years, of a Previous Report. J Bone Joint Surg Am. 2017; 99(22):1927-1931. DOI: 10.2106/JBJS.16.01109. View

12.

Deng W, Wu T, Wang Z, Shao H, Yang D, Zhou Y . Medial wall reconstruction using metal disc augments in revision total hip arthroplasty. Int Orthop. 2023; 47(5):1203-1212. DOI: 10.1007/s00264-023-05723-y. View

13.

Ulrich S, Seyler T, Bennett D, Delanois R, Saleh K, Thongtrangan I . Total hip arthroplasties: what are the reasons for revision?. Int Orthop. 2007; 32(5):597-604. PMC: 2551710. DOI: 10.1007/s00264-007-0364-3. View

14.

Shen X, Qin Y, Li Y, Tang X, Xiao J . Trabecular metal versus non-trabecular metal acetabular components for acetabular revision surgery: A systematic review and meta-analysis. Int J Surg. 2022; 100:106597. DOI: 10.1016/j.ijsu.2022.106597. View

15.

Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross A . Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss: a mid-term review. Bone Joint J. 2013; 95-B(2):166-72. DOI: 10.1302/0301-620X.95B2.30608. View

16.

Lee J, Kim T . Acetabular Cup Revision Arthroplasty Using Morselized Impaction Allograft. Hip Pelvis. 2018; 30(2):65-77. PMC: 5990533. DOI: 10.5371/hp.2018.30.2.65. View

17.

Oommen A, Krishnamoorthy V, Poonnoose P, Korula R . Fate of bone grafting for acetabular defects in total hip replacement. Indian J Orthop. 2015; 49(2):181-6. PMC: 4436484. DOI: 10.4103/0019-5413.152462. View

18.

Humphrey T, Baker C, Courtney P, Paprosky W, Bedair H, Sheth N . The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes. Hip Pelvis. 2023; 35(2):122-132. PMC: 10264228. DOI: 10.5371/hp.2023.35.2.122. View

19.

Ranawat C, Dorr L, INGLIS A . Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980; 62(7):1059-65. View

20.

Joshi R, Eftekhar N, McMahon D, Nercessian O . Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups. J Bone Joint Surg Br. 1998; 80(4):585-90. DOI: 10.1302/0301-620x.80b4.7361. View