Acetabular defect classification and management : Revision arthroplasty of the acetabular cup based on 3-point fixation.
Acetabuläre Defektklassifikation und Management : Revisionsarthroplastik der Hüftpfanne basierend auf der 3-Punkt-Fixation.
Computed tomography
Diagnostic imaging
Retrospective study
Revision arthroplasty
Total hip replacement
Journal
Der Orthopade
ISSN: 1433-0431
Titre abrégé: Orthopade
Pays: Germany
ID NLM: 0331266
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
pubmed:
1
3
2020
medline:
2
6
2020
entrez:
1
3
2020
Statut:
ppublish
Résumé
The purpose of this study was to provide a practicable and contemporary classification system that is reliable and pragmatic with respect to perioperative evaluation, planning, scientific comparison and analysis. This was a retrospective study of 160 patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup. The assessment of the acetabular defect was based on intraoperative description of the bony configuration of the acetabulum as well as on standardized preoperative planning images (pelvic overview and axial view of the hip joint). Preoperative computed tomography (CT) was carried out in individual cases. Acetabular bone defects were classified into 4 types based on whether or not a 3-point fixation of the acetabular cup within the boundaries of the acetabular cavity was possible. Minor segmental defects or cup loosening without bone loss can be treated with standard hemispherical acetabular components. Bone loss can be filled with bone grafts and/or treated by the appropriate acetabular component in order to ensure stable anchorage. When conventional revision cups are no longer suitable a custom made partial pelvic replacement can be used. The proposed classification mainly relies on intraoperative findings which were confirmed by preoperative imaging in 154 cases out of 160 (96.25%); however, meticulous preoperative planning based on X‑ray radiographs must be carried out. In addition, a CT scan must be performed whenever type III or type IV defects are anticipated. Compared to the existing classification systems, we can state that our classification system is practicable and pragmatic and simplifies the assessment of bone defects.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to provide a practicable and contemporary classification system that is reliable and pragmatic with respect to perioperative evaluation, planning, scientific comparison and analysis.
MATERIAL AND METHODS
METHODS
This was a retrospective study of 160 patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup. The assessment of the acetabular defect was based on intraoperative description of the bony configuration of the acetabulum as well as on standardized preoperative planning images (pelvic overview and axial view of the hip joint). Preoperative computed tomography (CT) was carried out in individual cases.
RESULTS
RESULTS
Acetabular bone defects were classified into 4 types based on whether or not a 3-point fixation of the acetabular cup within the boundaries of the acetabular cavity was possible. Minor segmental defects or cup loosening without bone loss can be treated with standard hemispherical acetabular components. Bone loss can be filled with bone grafts and/or treated by the appropriate acetabular component in order to ensure stable anchorage. When conventional revision cups are no longer suitable a custom made partial pelvic replacement can be used.
CONCLUSION
CONCLUSIONS
The proposed classification mainly relies on intraoperative findings which were confirmed by preoperative imaging in 154 cases out of 160 (96.25%); however, meticulous preoperative planning based on X‑ray radiographs must be carried out. In addition, a CT scan must be performed whenever type III or type IV defects are anticipated. Compared to the existing classification systems, we can state that our classification system is practicable and pragmatic and simplifies the assessment of bone defects.
Identifiants
pubmed: 32112227
doi: 10.1007/s00132-020-03895-8
pii: 10.1007/s00132-020-03895-8
pmc: PMC7198480
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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