Philip P Roessler1, Max Jaenisch2, Manuel Kuhlmann2, Miriam Wacker2, P Johannes Wagenhäuser3, Sascha Gravius2, Dieter C Wirtz2. 1. Department of Orthopedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. philip.roessler@ukbonn.de. 2. Department of Orthopedics and Traumatology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. 3. Department of Diagnostic Radiology, University Hospital Bonn, Bonn, Germany.
Abstract
PURPOSE: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity. The aim of the present study was to evaluate first short-term results of its clinical application, both clinical functional and patient-reported as well as radiographic. METHODS: Forty-four patients (28 female, 16 male, mean age 70.9 ± 11.5 years) could be followed for a mean of 26 ± 10 months after acetabular revision with a novel augment-and-modular-cage system. Indications for revision included aseptic loosening (68%), septic loosening (16%), or others (16%) with bone loss Paprosky IIa up to IIIb without discontinuity. The modified Harris Hip Score (mHHS) served as a primary outcome parameter. In addition, a number of patient-reported outcome measurements (PROMs) were collected including the Short Form 36 (SF-36), Hip disability and Osteoarthritis Outcome Score (HOOS), and Visual Analogue Scale for Hip Pain (VAS Hip) as well as overall satisfaction. Radiographic changes between the pre- and postoperative center of rotation (COR) and various criteria of implant failure served as secondary outcome parameters. RESULTS: No patients were lost to follow-up. Two implant-associated complications (partial flange breakage) without a need for revision surgery were detected, which represent a failure rate of 4.5%. Functional outcome as measured by mHHS increased from 49.4 ± 2.9 pre-operatively to 74.4 ± 3.1 at the latest follow-up (p < 0.001). PROMs showed significant improvements in all pain-related categories, while other quality-of-life measurements only exhibited positive tendencies towards improvement. VAS Hip significantly improved from 6.5 ± 0.7 pre-operatively to 2.2 ± 0.6 at the latest follow-up (p < 0.001). Radiographic evaluation showed that reconstruction of the COR was possible, referenced to the contralateral side. The COR could be lateralized by 5.0 mm (n.s.) and caudalized by 10.3 mm (p < 0.001) comparing pre-operative and post-operative states, with complete osseointegration in 95% of the cases. CONCLUSIONS: Treatment with the augment-and-modular-cage system significantly improved clinical functional and patient-reported outcomes in cases of acetabular revision after failed THA. In addition, a good reconstruction of the COR could also be achieved. Therefore, this highly modular system can be considered as an effective treatment option in almost all cases of acetabular bone loss except for those of pelvic discontinuity. It offers the unique possibility of intra-operative implant customization according to the existing bone defect and host bone quality.
PURPOSE: Acetabular revision of failed total hip arthroplasty (THA) is often associated with severe bone loss. Therefore, a variety of revision implant systems has been developed during recent years, with the augment-and-modular-cage system being one of the newest additions to this portfolio. Together with biologic downsizing by means of impaction bone grafting, this uncemented system promises a high modularity and versatility to treat all acetabular defects up to Paprosky types IIIa and IIIb without pelvic discontinuity. The aim of the present study was to evaluate first short-term results of its clinical application, both clinical functional and patient-reported as well as radiographic. METHODS: Forty-four patients (28 female, 16 male, mean age 70.9 ± 11.5 years) could be followed for a mean of 26 ± 10 months after acetabular revision with a novel augment-and-modular-cage system. Indications for revision included aseptic loosening (68%), septic loosening (16%), or others (16%) with bone loss Paprosky IIa up to IIIb without discontinuity. The modified Harris Hip Score (mHHS) served as a primary outcome parameter. In addition, a number of patient-reported outcome measurements (PROMs) were collected including the Short Form 36 (SF-36), Hip disability and Osteoarthritis Outcome Score (HOOS), and Visual Analogue Scale for Hip Pain (VAS Hip) as well as overall satisfaction. Radiographic changes between the pre- and postoperative center of rotation (COR) and various criteria of implant failure served as secondary outcome parameters. RESULTS: No patients were lost to follow-up. Two implant-associated complications (partial flange breakage) without a need for revision surgery were detected, which represent a failure rate of 4.5%. Functional outcome as measured by mHHS increased from 49.4 ± 2.9 pre-operatively to 74.4 ± 3.1 at the latest follow-up (p < 0.001). PROMs showed significant improvements in all pain-related categories, while other quality-of-life measurements only exhibited positive tendencies towards improvement. VAS Hip significantly improved from 6.5 ± 0.7 pre-operatively to 2.2 ± 0.6 at the latest follow-up (p < 0.001). Radiographic evaluation showed that reconstruction of the COR was possible, referenced to the contralateral side. The COR could be lateralized by 5.0 mm (n.s.) and caudalized by 10.3 mm (p < 0.001) comparing pre-operative and post-operative states, with complete osseointegration in 95% of the cases. CONCLUSIONS: Treatment with the augment-and-modular-cage system significantly improved clinical functional and patient-reported outcomes in cases of acetabular revision after failed THA. In addition, a good reconstruction of the COR could also be achieved. Therefore, this highly modular system can be considered as an effective treatment option in almost all cases of acetabular bone loss except for those of pelvic discontinuity. It offers the unique possibility of intra-operative implant customization according to the existing bone defect and host bone quality.
Authors: J R Lieberman; F Dorey; P Shekelle; L Schumacher; D J Kilgus; B J Thomas; G A Finerman Journal: J Arthroplasty Date: 1997-09 Impact factor: 4.757
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