Treatment of Paprosky Type IIIA-B Acetabular Defects and Pelvic Discontinuity With Custom 3D Implants: Medium-Term Results
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Published:
Oct 17, 2023
Keywords:
Acetabular defect, 3D cup, custom implant, reconstruction
Main Article Content
Abstract
Introduction: Acetabular revision is a particularly challenging surgery when there is loss of bone stock and extensive acetabular defects. 3D implants can make up for these defects and adapt to each circumstance. The objective of this study was to evaluate clinical and radiographic outcomes in patients with severe acetabular defects treated with 3D-printed implants and determine the appropriate cup constraint for each patient.
Materials and Methods: A retrospective study was carried out on 10 patients with severe acetabular defects classified as Paprosky type IIIA-B and pelvic discontinuity who underwent surgery with a custom 3Dprintedacetabular prosthesis, carried out by the same surgery team between 2016 and 2022.
Results: The average follow-up was 40.5 months. The Harris hip score improved significantly from an average of 24.2 to 63.5 at the last follow-up. No signs of loosening or migration of the 3D cup in terms of inclination and anteversion were observed in any case, at the last control.
Conclusion: Custom-made acetabular implants represent a valid solution to treat severe acetabular bone defects and pelvic discontinuity.
Materials and Methods: A retrospective study was carried out on 10 patients with severe acetabular defects classified as Paprosky type IIIA-B and pelvic discontinuity who underwent surgery with a custom 3Dprintedacetabular prosthesis, carried out by the same surgery team between 2016 and 2022.
Results: The average follow-up was 40.5 months. The Harris hip score improved significantly from an average of 24.2 to 63.5 at the last follow-up. No signs of loosening or migration of the 3D cup in terms of inclination and anteversion were observed in any case, at the last control.
Conclusion: Custom-made acetabular implants represent a valid solution to treat severe acetabular bone defects and pelvic discontinuity.
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How to Cite
Vega, C. A., Moruno, F., Garavano, E., Sued, M., & Palomino Prado, E. (2023). Treatment of Paprosky Type IIIA-B Acetabular Defects and Pelvic Discontinuity With Custom 3D Implants: Medium-Term Results. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 511-519. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1760
Section
Clinical Research
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12. Amenabar T, Rahman WA, Hetaimish BM, Kuzyk PR, Safir OA, Gross AE. Promising mid-term results with a cupcage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res 2016;474:408-14.
https://doi.org/10.1007/s11999-015-4210-4
13. Wind MA, Swank ML, Sorger JI. Short-term results of a custom trifange acetabular component for massive
acetabular bone loss in revision THA. Orthopedics 2013;36:e260-e265. https://doi.org/10.3928/01477447-20130222-11
14. Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ. Pelvic discontinuity treated with custom
trifange component: a reliable option. Clin Orthop Relat Res 2012;470:428-34. https://doi.org/10.1007/s11999-011-2126-1
15. DeBoer DK, Brinson MR, Morrison IC. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg
Am 2007;89:835-40. https://doi.org/10.2106/JBJS.F.00313
16. Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 2020;140:415-24. https://doi.org/10.1007/s00402-020-03334-5
17. De Martino I, Strigelli V, Cacciola G, Gu A, Bostrom MP, Sculco PK. Survivorship and clinical outcomes of custom trifange acetabular components in revision total hip arthroplasty: a systematic review. J Arthroplasty 2019;34:2511- 8. https://doi.org/10.1016/j.arth.2019.05.032
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780-5. https://doi.org/10.2106/JBJS.F.00222
2. Khanduja V. Total hip arthroplasty in 2017—current concepts and recent advances. Indian J Orthop 2017;51:357-8. https://doi.org/10.4103/ortho.IJOrtho_367_17
3. Baauw M, van Hooff ML, Spruit M. Current construct options for revision of large acetabular defects: a systematic review. JBJS Rev 2016;4(11):e2. https://doi.org/10.2106/JBJS.RVW.15.00119
4. Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, et al. Management of severe
periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 2017;38:2455-61. https://doi.org/10.1007/s00264-014-2443-6
5. Berasi CC, Berend KR, Adams JB, Ruh EL, Lombardi AV. Are custom trifange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res 2015;473:528-35. https://doi.org/10.1007/s11999-014-3969-z
6. Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP. The position and orientation of total
knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT
reconstruction. J Bone Joint Surg Br 2011;93:629-33. https://doi.org/10.1302/0301-620X.93B5.25893
7. Kalteis T, Handel M, Herold T, Perlick L, Paetzel C, Grifka J. Position of the acetabular cup – accuracy of
radiographic calculation compared to CT-based measurement. Eur J Radiol 2006;58:294-300.
https://doi.org/10.1016/j.ejrad.2005.10.003
8. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision
arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9:33-44. https://doi.org/10.1016/0883-5403(94)90135-x
9. Gelaude F, Clijmans T, Delport J. Quantitative computerized assessment of the degree of acetabular bone deficiency: total radial acetabular bone loss (TrABL). Adv Orthop 2011:494382. https://doi.org/10.4061/2011/494382
10. Manaster BJ. From the RSNA refresher courses: total hip arthroplasty—radiographic evaluation. RadioGraphics 1996;16:645-60. https://doi.org/10.1148/radiographics.16.3.8897629
11. Sembrano JN, Cheng EY. Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res 2008;466:1657-65. https://doi.org/10.1007/s1 1999-008-0183-x
12. Amenabar T, Rahman WA, Hetaimish BM, Kuzyk PR, Safir OA, Gross AE. Promising mid-term results with a cupcage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res 2016;474:408-14.
https://doi.org/10.1007/s11999-015-4210-4
13. Wind MA, Swank ML, Sorger JI. Short-term results of a custom trifange acetabular component for massive
acetabular bone loss in revision THA. Orthopedics 2013;36:e260-e265. https://doi.org/10.3928/01477447-20130222-11
14. Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ. Pelvic discontinuity treated with custom
trifange component: a reliable option. Clin Orthop Relat Res 2012;470:428-34. https://doi.org/10.1007/s11999-011-2126-1
15. DeBoer DK, Brinson MR, Morrison IC. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg
Am 2007;89:835-40. https://doi.org/10.2106/JBJS.F.00313
16. Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G. Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 2020;140:415-24. https://doi.org/10.1007/s00402-020-03334-5
17. De Martino I, Strigelli V, Cacciola G, Gu A, Bostrom MP, Sculco PK. Survivorship and clinical outcomes of custom trifange acetabular components in revision total hip arthroplasty: a systematic review. J Arthroplasty 2019;34:2511- 8. https://doi.org/10.1016/j.arth.2019.05.032