Jun-Ki Moon1, Jaejoon Ryu2, Yeesuk Kim2, Jae-Hyuk Yang1, Kyu-Tae Hwang2, Young-Ho Kim3. 1. Department of Orthopedic Surgery, Hanyang University Guri Hospital, Gyomoon-dong 249-1, Guri city, Gyunggi-do, 471-701, South Korea. 2. Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea. 3. Department of Orthopedic Surgery, Hanyang University Guri Hospital, Gyomoon-dong 249-1, Guri city, Gyunggi-do, 471-701, South Korea. kimyh1@hanyang.ac.kr.
Abstract
INTRODUCTION: Acetabular revision arthroplasty using jumbo cups for moderate-to-severe acetabular defects has varied outcomes. We evaluated the clinical and radiological outcomes of acetabular revision arthroplasty using a press-fitted jumbo cup and sought to identify factors that influence outcomes during intermediate follow-up. MATERIALS AND METHODS: Eighty patients (47 men, 33 women; 80 hips) who underwent acetabular revision arthroplasty using press-fitted jumbo cups were included. The mean follow-up period was 10.4 years. Harris hip score (HHS), presence of groin pain, radiographic results, and Kaplan-Meier survival curves were evaluated. Implant design and surgery-related and patient-related factors were assessed to identify influential factors for cup loosening. Migration and wear analyses were performed using Einzel-Bild-Röntgen-Analyse software. RESULTS: The mean preoperative HHS of 53 had improved to 77 at the final follow-up (p = 0.005). Nine patients experienced groin pain. Acetabular cup loosening was observed in seven cups (8.7%), and one jumbo cup was replaced with a reinforcement cage. The survival rate of the acetabular cup was 91% at 16 years according to the Kaplan-Meier analysis. Osteolysis was identified around the cup in six cases (7.5%). Acetabular cup loosening occurred more frequently in patients with conventional polyethylene liners than in those with highly cross-linked polyethylene liners (p = 0.045). The mean total migration was 1.52 mm, and the mean total wear was 0.98 mm. There was a positive correlation between total migration and total wear (p = 0.023; Spearman's rho = 0.388). The mean wear rate of the patients with the cup inclination angle < 50° was significantly lower than those with the cup inclination angle > 50° (p = 0.001). There were four cases of complications (three dislocations and one infection) that did not require revision surgery. CONCLUSION: Press-fitted jumbo cups for acetabular revision arthroplasty exhibited encouraging results during follow-up for an average of 10 years. Use of highly cross-linked polyethylene liners and proper placement of the acetabular component with an inclination angle < 50° may contribute to better clinical outcomes after acetabular revision arthroplasty with jumbo cups.
INTRODUCTION: Acetabular revision arthroplasty using jumbo cups for moderate-to-severe acetabular defects has varied outcomes. We evaluated the clinical and radiological outcomes of acetabular revision arthroplasty using a press-fitted jumbo cup and sought to identify factors that influence outcomes during intermediate follow-up. MATERIALS AND METHODS: Eighty patients (47 men, 33 women; 80 hips) who underwent acetabular revision arthroplasty using press-fitted jumbo cups were included. The mean follow-up period was 10.4 years. Harris hip score (HHS), presence of groin pain, radiographic results, and Kaplan-Meier survival curves were evaluated. Implant design and surgery-related and patient-related factors were assessed to identify influential factors for cup loosening. Migration and wear analyses were performed using Einzel-Bild-Röntgen-Analyse software. RESULTS: The mean preoperative HHS of 53 had improved to 77 at the final follow-up (p = 0.005). Nine patients experienced groin pain. Acetabular cup loosening was observed in seven cups (8.7%), and one jumbo cup was replaced with a reinforcement cage. The survival rate of the acetabular cup was 91% at 16 years according to the Kaplan-Meier analysis. Osteolysis was identified around the cup in six cases (7.5%). Acetabular cup loosening occurred more frequently in patients with conventional polyethylene liners than in those with highly cross-linked polyethylene liners (p = 0.045). The mean total migration was 1.52 mm, and the mean total wear was 0.98 mm. There was a positive correlation between total migration and total wear (p = 0.023; Spearman's rho = 0.388). The mean wear rate of the patients with the cup inclination angle < 50° was significantly lower than those with the cup inclination angle > 50° (p = 0.001). There were four cases of complications (three dislocations and one infection) that did not require revision surgery. CONCLUSION: Press-fitted jumbo cups for acetabular revision arthroplasty exhibited encouraging results during follow-up for an average of 10 years. Use of highly cross-linked polyethylene liners and proper placement of the acetabular component with an inclination angle < 50° may contribute to better clinical outcomes after acetabular revision arthroplasty with jumbo cups.