Use of 3D Cups in Severe Acetabular Defects
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Published:
Oct 24, 2022
Keywords:
Pelvic discontinuity, 3D cup, dual mobility, reconstructive acetabular revision, severe acetabular defects
Main Article Content
Abstract
Introduction: Given the increase in hip arthroplasties in the last century, serious acetabular defects are increasingly frequent events. Their treatment represents a real challenge, due to the bone deficit and poor bone quality that these patients usually present.
Materials and Methods: Six patients treated between 2016 and 2021 are presented. Five cases of pelvic discontinuity due to failed revisions, classified as Paprosky type IIIB, and one transverse fracture of the acetabulum, a possible treatment option in cases of osteoporotic patients.
Results: The patients treated with this multidisciplinary technique were followed up for an average of 20 months, and none of them presented postoperative complications. The results evaluated by analogous scales are promising and invite us to establish this procedure as the gold standard.
Conclusions: Strict evaluation is necessary for acetabular defects. The inclusion of medical IT makes it possible to study the need to use bank grafting and to manufacture custom-made multiporous trabecular titanium/tantalum implants, which is ideal for achieving osseointegration, added to the possibility of planning the direction and length of the screws to the remaining bone, according to its quality. The cementation of a dual mobility cup inside the customized implant reduces the risk of dislocation and overload of the latter, by eliminating metal-metal friction.
Materials and Methods: Six patients treated between 2016 and 2021 are presented. Five cases of pelvic discontinuity due to failed revisions, classified as Paprosky type IIIB, and one transverse fracture of the acetabulum, a possible treatment option in cases of osteoporotic patients.
Results: The patients treated with this multidisciplinary technique were followed up for an average of 20 months, and none of them presented postoperative complications. The results evaluated by analogous scales are promising and invite us to establish this procedure as the gold standard.
Conclusions: Strict evaluation is necessary for acetabular defects. The inclusion of medical IT makes it possible to study the need to use bank grafting and to manufacture custom-made multiporous trabecular titanium/tantalum implants, which is ideal for achieving osseointegration, added to the possibility of planning the direction and length of the screws to the remaining bone, according to its quality. The cementation of a dual mobility cup inside the customized implant reduces the risk of dislocation and overload of the latter, by eliminating metal-metal friction.
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How to Cite
Troncoso, I., Sabatella , C., & Blanco O´denaG. J. (2022). Use of 3D Cups in Severe Acetabular Defects. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 676-684. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1567
Section
Clinical Research
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References
1. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9(1):33-44. https://doi.org/10.1016/0883-5403(94)90135-x
2. Callaghan J, Rosenberg A, Rubash HE. Cadera, 2ª ed. Madrid: Marban; 2017.
3. Gelaude F, Clijmans T, Delport H. Quantitative computerized assessment of the degree of acetabular bone deficiency: Total radial acetabular bone loss (TrABL). Adv Orthop 2011;2011:494382. https://doi.org/10.4061/2011/494382
4. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons. Arthritis Care Res 2011;63(Suppl 11):S200-7. https://doi.org/10.1002/acr.20549
5. Ugino FK, Righetti CM, Alves DP, Guimarães RP, Honda EK, Ono NK. Evaluation of the reliability of the modified Merle d’Aubigné and Postel Method. Acta Ortop Bras 2012;20(4):213-7. https://doi.org/10.1590/S1413-78522012000400004
6. Bobyn JD, Stackpool GJ, Hacking S, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 1999;81:907-14.
https://doi.org/10.1302/0301-620X.81B5.9283
7. Meneghini RM, Meyer C, Buckley CA, Hanssen AD, Lewallen DG. Mechanical stability of novel highly porous metal acetabular components in revision total hip arthroplasty. J Arthroplasty 2010;25(3):337-41. https://doi.org/10.1016/j.arth.2009.03.003
8. Philippeau JM, Durand JM, Carret JP, Leclercq S, Waast D, Gouin F. Dual mobility design use in preventing total hip replacement dislocation following tumor resection. Orthop Traumatol Surg Res 2010;96(1):2-8. https://doi.org/10.1016/j.rcot.2009.12.011
9. Mudrick CA, Melvin JS, Springer BD. Late posterior hip instability after lumbar spinopelvic fusion. Arthroplast Today 2015;1(2):25-9. https://doi.org/10.1016/j.artd.2015.05.002
10. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH; French Society of Orthopaedic Surgery and Traumatology (SoFCOT). Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res 2012;98(3):296-300. https://doi.org/10.1016/j.otsr.2012.01.005
11. Baauw M, van Hellemondt GG, Spruit M. A custom-made acetabular implant for Paprosky type 3 defects. Orthopedics 2017;40(1):e195-e198. https://doi.org/10.3928/01477447-20160902-01
12. Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 2001;83(9):1352-7. https://doi.org/10.2106/00004623-200109000-00010
13. 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. https://doi.org/10.1054/arth.2001.23919
14. Paprosky WG, O’Rourke M, Sporer SM. The treatment of acetabular bone defects with an associated pelvic discontinuity. Clin Orthop Relat Res 2005;441:216-20. https://doi.org/10.1097/01.blo.0000194311.20901.f9
15. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK. Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res 2001;(393):216-27.
https://doi.org/10.1097/00003086-200112000-00024
16. Holt GE, Dennis DA. Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 2005;429:209-14. https://doi.org/10.1097/01.blo.0000150252.19780.74
17. Joshi AB, Lee J, Christensen C. Results for a custom acetabular component for acetabular deficiency. J Arthroplasty 2002;17(5):643-8. https://doi.org/10.1054/arth.2002.32106
18. Wind MA Jr, Swank ML, Sorger JI. Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 2013;36(3):e260-5. https://doi.org/10.3928/01477447-20130222-11
19. Belzino MD, Ottolenghi J, Lupacchini M, Ivalde F, Espagnol R, Melo LM. Diseño digital 3D a medida para defectos óseos de cadera. Revista Acaro 2020;6(1):1-7. Disponible en: https://acarorevista.org.ar/joomla-pages-iii/categories-list/56-la-revista/ultima-edicion/julio-2020-vol-6-num-1/213-diseno-digital-3d-a-medida-para-defectososeos-de-cadera#:~:text=La%20utilizaci%C3%B3n%20del%20modelo%20en,de%20manera%20precisa%20y%20personalizada
2. Callaghan J, Rosenberg A, Rubash HE. Cadera, 2ª ed. Madrid: Marban; 2017.
3. Gelaude F, Clijmans T, Delport H. Quantitative computerized assessment of the degree of acetabular bone deficiency: Total radial acetabular bone loss (TrABL). Adv Orthop 2011;2011:494382. https://doi.org/10.4061/2011/494382
4. Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons. Arthritis Care Res 2011;63(Suppl 11):S200-7. https://doi.org/10.1002/acr.20549
5. Ugino FK, Righetti CM, Alves DP, Guimarães RP, Honda EK, Ono NK. Evaluation of the reliability of the modified Merle d’Aubigné and Postel Method. Acta Ortop Bras 2012;20(4):213-7. https://doi.org/10.1590/S1413-78522012000400004
6. Bobyn JD, Stackpool GJ, Hacking S, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br 1999;81:907-14.
https://doi.org/10.1302/0301-620X.81B5.9283
7. Meneghini RM, Meyer C, Buckley CA, Hanssen AD, Lewallen DG. Mechanical stability of novel highly porous metal acetabular components in revision total hip arthroplasty. J Arthroplasty 2010;25(3):337-41. https://doi.org/10.1016/j.arth.2009.03.003
8. Philippeau JM, Durand JM, Carret JP, Leclercq S, Waast D, Gouin F. Dual mobility design use in preventing total hip replacement dislocation following tumor resection. Orthop Traumatol Surg Res 2010;96(1):2-8. https://doi.org/10.1016/j.rcot.2009.12.011
9. Mudrick CA, Melvin JS, Springer BD. Late posterior hip instability after lumbar spinopelvic fusion. Arthroplast Today 2015;1(2):25-9. https://doi.org/10.1016/j.artd.2015.05.002
10. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH; French Society of Orthopaedic Surgery and Traumatology (SoFCOT). Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res 2012;98(3):296-300. https://doi.org/10.1016/j.otsr.2012.01.005
11. Baauw M, van Hellemondt GG, Spruit M. A custom-made acetabular implant for Paprosky type 3 defects. Orthopedics 2017;40(1):e195-e198. https://doi.org/10.3928/01477447-20160902-01
12. Whaley AL, Berry DJ, Harmsen WS. Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 2001;83(9):1352-7. https://doi.org/10.2106/00004623-200109000-00010
13. 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. https://doi.org/10.1054/arth.2001.23919
14. Paprosky WG, O’Rourke M, Sporer SM. The treatment of acetabular bone defects with an associated pelvic discontinuity. Clin Orthop Relat Res 2005;441:216-20. https://doi.org/10.1097/01.blo.0000194311.20901.f9
15. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK. Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res 2001;(393):216-27.
https://doi.org/10.1097/00003086-200112000-00024
16. Holt GE, Dennis DA. Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 2005;429:209-14. https://doi.org/10.1097/01.blo.0000150252.19780.74
17. Joshi AB, Lee J, Christensen C. Results for a custom acetabular component for acetabular deficiency. J Arthroplasty 2002;17(5):643-8. https://doi.org/10.1054/arth.2002.32106
18. Wind MA Jr, Swank ML, Sorger JI. Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 2013;36(3):e260-5. https://doi.org/10.3928/01477447-20130222-11
19. Belzino MD, Ottolenghi J, Lupacchini M, Ivalde F, Espagnol R, Melo LM. Diseño digital 3D a medida para defectos óseos de cadera. Revista Acaro 2020;6(1):1-7. Disponible en: https://acarorevista.org.ar/joomla-pages-iii/categories-list/56-la-revista/ultima-edicion/julio-2020-vol-6-num-1/213-diseno-digital-3d-a-medida-para-defectososeos-de-cadera#:~:text=La%20utilizaci%C3%B3n%20del%20modelo%20en,de%20manera%20precisa%20y%20personalizada