Effectiveness of acetabular revision using a metal reconstruction cage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YOU Zhenjun ¹ , SUN Junying ² , JIANG Yi ¹ , LIU Shiliang ¹ , WU Keqin ¹ , LI Zhe ¹ , QIN Li ¹

1. Department of Orthopaedics, the First Hospital of Jiaxing, Jiaxing Zhejiang, 314000, P.R.China;
2. Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215006, P.R.China;

Corresponding?author：

YOU Zhenjun, Email: zhenjun_110@163.com

Keywords：

Total hip arthroplasty; acetabulum; revision; metal reconstruction cage

DOI：

10.7507/1002-1892.201701017

Video：

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ObjectiveTo explore the clinical outcomes of acetabular revision using a metal reconstruction cage. MethodsBetween October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. ConclusionThe metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.

Citation： YOU Zhenjun, SUN Junying, JIANG Yi, LIU Shiliang, WU Keqin, LI Zhe, QIN Li. Effectiveness of acetabular revision using a metal reconstruction cage. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 641-646. doi: 10.7507/1002-1892.201701017 Copy

1.	孫俊英. 人工髖關節翻修手術學. 北京: 人民軍醫出版社, 2012: 201-211.
2.	Sembrano JN, Cheng EY. Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res, 2008, 466(7): 1657-1665.
3.	何銳, 楊柳, 陳光興, 等. 鉭金屬臼杯重建髖臼骨缺損的近期療效. 中華骨科雜志, 2013, 33(3): 206-213.
4.	Ilyas I, Alrumaih HA, Kashif S, et al. Revision of Type III and Type IVB Acetabular Defects With Burch-Schneider Anti-Protrusio Cages. J Arthroplasty, 2015, 30(2): 259-264.
5.	游鎮君, 孫俊英, 查國春, 等. 生物型人工全髖關節置換術治療股骨近段畸形合并終極髖關節疾病. 中國修復重建外科雜志, 2015, 29(3): 265-269.
6.	Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 517-525.
7.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
8.	Berry DJ. Femoral revision: distal fixation with fluted, tapered grit-blasted stems. J Arthroplast, 2002, 17(4 Suppl 1): 142-146.
9.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
10.	Kim DH, Cho SH, Jeong ST, et al. Restoration of the center of rotation in revision total hip arthroplasty. J Arthroplasty, 2010, 25(7): 1041-1046.
11.	Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
12.	Busch VJ, Gardeniers JW, Verdonschot N, et al. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg (Am), 2011, 93(4): 367-371.
13.	Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
14.	Shon WY, Santhanam SS, Choi JW. Acetabular Reconstruction in Total Hip Arthroplasty. Hip Pelvis, 2016, 28(1): 11-14.
15.	M?kinen TJ, Fichman SG, Watts E, et al. The role of cages in the management of severe acetabular bone defects at revision arthroplasty. Bone Joint J, 2016, 98-B(1 Suppl A): 73-77.
16.	Goodman S, Saastamoinen H, Shasha N, et al. Complications of ilioischial reconstruction rings in revision total hip arthroplasty. J Arthroplasty, 2004, 19(4): 436-446.
17.	Duffy GP, O’Connor MI, Brodersen MP. Fatigue failure of the GAP ring. J Arthroplasty, 2007, 22(5): 711-714.
18.	Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg (Br), 1992, 74(5): 716-720.
19.	Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res, 2000, (378): 155-168.
20.	Winter E, Piert M, Volkmann R, et al. Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(6): 862-867.
21.	吳浩波, 嚴世貴, 王祥華, 等. 防內突加強杯用于髖臼側骨缺損翻修的臨床研究. 中華骨科雜志, 2013, 33(3): 193-199.
22.	Amenabar T, Rahman WA, Hetaimish BM, et al. Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity. Clin Orthop Relat Res, 2016, 474(2): 408-414.
23.	Udomkiat P, Dorr LD, Won YY, et al. Technical factors for success with metal ring acetabular reconstruction. J Arthroplasty, 2001, 16(8): 961-969.
24.	萬國楊, 孫俊英, 查國春, 等. 第三代陶對陶人工全髖關節置換術治療中青年髖關節疾病的中遠期療效. 中國修復重建外科雜志, 2015, 29(9): 1057-1061.
25.	M?kinen TJ, Kuzyk P, Safir OA, et al. Role of Cages in Revision Arthroplasty of the Acetabulum. J Bone Joint Surg (Am), 2016, 98(3): 233-242.
26.	魏召勸, 孫俊英, 查國春, 等. 采用高交聯聚乙烯與傳統聚乙烯髖臼內襯行人工全髖關節置換的比較研究. 中國修復重建外科雜志, 2013, 27(12): 1414-1418.

1. 孫俊英. 人工髖關節翻修手術學. 北京: 人民軍醫出版社, 2012: 201-211.
2. Sembrano JN, Cheng EY. Acetabular cage survival and analysis of factors related to failure. Clin Orthop Relat Res, 2008, 466(7): 1657-1665.
3. 何銳, 楊柳, 陳光興, 等. 鉭金屬臼杯重建髖臼骨缺損的近期療效. 中華骨科雜志, 2013, 33(3): 206-213.
4. Ilyas I, Alrumaih HA, Kashif S, et al. Revision of Type III and Type IVB Acetabular Defects With Burch-Schneider Anti-Protrusio Cages. J Arthroplasty, 2015, 30(2): 259-264.
5. 游鎮君, 孫俊英, 查國春, 等. 生物型人工全髖關節置換術治療股骨近段畸形合并終極髖關節疾病. 中國修復重建外科雜志, 2015, 29(3): 265-269.
6. Zha GC, Sun JY, Dong SJ. Less anterior knee pain with a routine lateral release in total knee arthroplasty without patellar resurfacing: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc, 2014, 22(3): 517-525.
7. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
8. Berry DJ. Femoral revision: distal fixation with fluted, tapered grit-blasted stems. J Arthroplast, 2002, 17(4 Suppl 1): 142-146.
9. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
10. Kim DH, Cho SH, Jeong ST, et al. Restoration of the center of rotation in revision total hip arthroplasty. J Arthroplasty, 2010, 25(7): 1041-1046.
11. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
12. Busch VJ, Gardeniers JW, Verdonschot N, et al. Acetabular reconstruction with impaction bone-grafting and a cemented cup in patients younger than fifty years old: a concise follow-up, at twenty to twenty-eight years, of a previous report. J Bone Joint Surg (Am), 2011, 93(4): 367-371.
13. Philippe R, Gosselin O, Sedaghatian J, et al. Acetabular reconstruction using morselized allograft and a reinforcement ring for revision arthroplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res, 2012, 98(2): 129-137.
14. Shon WY, Santhanam SS, Choi JW. Acetabular Reconstruction in Total Hip Arthroplasty. Hip Pelvis, 2016, 28(1): 11-14.
15. M?kinen TJ, Fichman SG, Watts E, et al. The role of cages in the management of severe acetabular bone defects at revision arthroplasty. Bone Joint J, 2016, 98-B(1 Suppl A): 73-77.
16. Goodman S, Saastamoinen H, Shasha N, et al. Complications of ilioischial reconstruction rings in revision total hip arthroplasty. J Arthroplasty, 2004, 19(4): 436-446.
17. Duffy GP, O’Connor MI, Brodersen MP. Fatigue failure of the GAP ring. J Arthroplasty, 2007, 22(5): 711-714.
18. Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg (Br), 1992, 74(5): 716-720.
19. Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res, 2000, (378): 155-168.
20. Winter E, Piert M, Volkmann R, et al. Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg (Am), 2001, 83-A(6): 862-867.
21. 吳浩波, 嚴世貴, 王祥華, 等. 防內突加強杯用于髖臼側骨缺損翻修的臨床研究. 中華骨科雜志, 2013, 33(3): 193-199.
22. Amenabar T, Rahman WA, Hetaimish BM, et al. Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity. Clin Orthop Relat Res, 2016, 474(2): 408-414.
23. Udomkiat P, Dorr LD, Won YY, et al. Technical factors for success with metal ring acetabular reconstruction. J Arthroplasty, 2001, 16(8): 961-969.
24. 萬國楊, 孫俊英, 查國春, 等. 第三代陶對陶人工全髖關節置換術治療中青年髖關節疾病的中遠期療效. 中國修復重建外科雜志, 2015, 29(9): 1057-1061.
25. M?kinen TJ, Kuzyk P, Safir OA, et al. Role of Cages in Revision Arthroplasty of the Acetabulum. J Bone Joint Surg (Am), 2016, 98(3): 233-242.
26. 魏召勸, 孫俊英, 查國春, 等. 采用高交聯聚乙烯與傳統聚乙烯髖臼內襯行人工全髖關節置換的比較研究. 中國修復重建外科雜志, 2013, 27(12): 1414-1418.

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