Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity
- 1 February 2016
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 474 (2), 408-414
- https://doi.org/10.1007/s11999-015-4210-4
Abstract
Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cup-cage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges.We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on Merle d'Aubigné-Postel scores; (3) radiological outcomes based primarily on construct migration; and (4) the complication rate for a series of 67 CC procedures performed at our institution.All hip revision procedures between January 2003 and March 2012 where a CC was used (with the exception of tumor cases or acute fracture; four total cases) that had a minimum 2-year followup and that had been seen within the last 2 years were included in this retrospective review. Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification. Sixty-seven CC procedures with an average followup of 74 months (range, 24-135 months; SD, 34.3) months were identified; 26 of 67 (39%) were Gross Type IV and 41 of 67 (61%) were Gross Type V (pelvic discontinuity). Postoperative clinical and radiological evaluation was done annually. Merle d'Aubigné-Postel scores were recorded and all radiographs were compared with the 6-week postoperative radiographs to evaluate for radiographic loosening or migration. Failure was defined as revision surgery for any cause, including infection.The 5-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1-97.4), and the 10-year survival rate was 85% (95% CI, 67.2-93.8). The Merle d'Aubigné-Postel score improved significantly from a mean of 6 preoperatively to 13 postoperatively (p < 0.001). Four CC had nonprogressive radiological migration of the ischial flange and they remain stable.We believe that the CC construct is a suitable choice to treat chronic pelvic discontinuity; it also remains a reliable option for the treatment of severe acetabular bone defects if stable fixation cannot be obtained through the use of a trabecular metal cup with or without augments.Level IV, therapeutic study.Keywords
This publication has 30 references indexed in Scilit:
- Tantalum Augments for Paprosky IIIA Defects Remain Stable at Midterm FollowupClinical Orthopaedics and Related Research, 2012
- Pelvic Discontinuity Treated With Custom Triflange Component: A Reliable OptionClinical Orthopaedics and Related Research, 2012
- Bone Remodeling Around Porous Metal Cementless Acetabular ComponentsThe Journal of Arthroplasty, 2010
- Tantalum Components in Difficult Acetabular RevisionsClinical Orthopaedics and Related Research, 2010
- Salvage of Failed Acetabular Cages by Nonbuttressed Trabecular Metal CupsClinical Orthopaedics and Related Research, 2010
- Trabecular Metal™ Cups for Acetabular Defects With 50% or Less Host Bone ContactClinical Orthopaedics and Related Research, 2009
- Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuityThe Journal of Bone and Joint Surgery. British volume, 2009
- Late presentation of sciatic neuropathy after failure of acetabular reconstruction rings in revision hip arthroplasty: a report of two casesCurrent Orthopaedic Practice, 2008
- The Bürch-Schneider anti-protrusio cage in revision total hip arthroplastyThe Journal of Bone and Joint Surgery. British volume, 1998
- Evaluation of cementless acetabular component migration: An experimental studyThe Journal of Arthroplasty, 1989