Hip Reconstruction In Situ with Screws and Cement (HiRISC) construct to treat large acetabular bone defects.
Journal
The bone & joint journal
ISSN: 2049-4408
Titre abrégé: Bone Joint J
Pays: England
ID NLM: 101599229
Informations de publication
Date de publication:
01 May 2024
01 May 2024
Historique:
medline:
1
5
2024
pubmed:
1
5
2024
entrez:
30
4
2024
Statut:
epublish
Résumé
Large bone defects resulting from osteolysis, fractures, osteomyelitis, or metastases pose significant challenges in acetabular reconstruction for total hip arthroplasty. This study aimed to evaluate the survival and radiological outcomes of an acetabular reconstruction technique in patients at high risk of reconstruction failure (i.e. periprosthetic joint infection (PJI), poor bone stock, immunosuppressed patients), referred to as Hip Reconstruction In Situ with Screws and Cement (HiRISC). This involves a polyethylene liner embedded in cement-filled bone defects reinforced with screws and/or plates for enhanced fixation. A retrospective chart review of 59 consecutive acetabular reconstructions was performed by four surgeons in a single institution from 18 October 2018 to 5 January 2023. Cases were classified based on the Paprosky classification, excluding type 1 cases (n = 26) and including types 2 or 3 for analysis (n = 33). Radiological loosening was evaluated by an orthopaedic surgeon who was not the operating surgeon, by comparing the immediate postoperative radiographs with the ones at latest follow-up. Mean follow-up was 557 days (SD 441; 31 to 1,707). Out of the 33 cases analyzed, six (18.2%) constructs required revision, with four revisions due to uncontrolled infection, one for dislocation, and one for aseptic loosening. Among the 27 non-revised constructs, only one showed wider radiolucencies compared to immediate postoperative radiographs, indicating potential loosening. Patients who underwent revision (n = 6) were significantly younger and had a higher BMI compared to those with non-revised constructs (p = 0.016 and p = 0.026, respectively). Sex, race, ethnicity, American Society of Anesthesiologists grade, infection status (patients with postoperative PJI diagnosis (septic) vs patients without such diagnosis (aseptic)), and mean follow-up did not significantly differ between revised and non-revised groups. The HiRISC technique may serve as a feasible short-term (about one to two years) alternative in patients with large acetabular defects, particularly in cases of PJI. Longer follow-up is necessary to establish the long-term survival of this technique.
Identifiants
pubmed: 38688509
doi: 10.1302/0301-620X.106B5.BJJ-2023-0834.R1
pii: BJJ-2023-0834.R1
doi:
Substances chimiques
Bone Cements
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
82-88Informations de copyright
© 2024 The British Editorial Society of Bone & Joint Surgery.
Déclaration de conflit d'intérêts
None declared.
Références
Jacquet C , Flecher X , Pioger C , Fabre-Aubrespy M , Ollivier M , Argenson J-N . Long-term results of custom-made femoral stems . Orthopade . 2020 ; 49 ( 5 ): 408 – 416 . 10.1007/s00132-020-03901-z 32240324
Mears DC , Velyvis JH . Primary total hip arthroplasty after acetabular fracture . Instr Course Lect . 2001 ; 50 : 335 – 354 . 11372332
Ghanem M , Zajonz D , Heyde C-E , Roth A . Acetabular defect classification and management: revision arthroplasty of the acetabular cup based on 3-point fixation . Orthopade . 2020 ; 49 ( 5 ): 432 – 442 . 10.1007/s00132-020-03895-8 32112227
Mancino F , Cacciola G , Di Matteo V , et al. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty . Orthop Rev (Pavia) . 2020 ; 12 ( Suppl 1 ): 8655 . 10.4081/or.2020.8655 32913591
Shon WY , Santhanam SS , Choi JW . Acetabular reconstruction in total hip arthroplasty . Hip Pelvis . 2016 ; 28 ( 1 ): 1 – 14 . 10.5371/hp.2016.28.1.1 27536638
Aqil A , Shah N . Diagnosis of the failed total hip replacement . J Clin Orthop Trauma . 2020 ; 11 ( 1 ): 2 – 8 . 10.1016/j.jcot.2019.11.003 32001976
Migliorini F , La Padula G , Torsiello E , Spiezia F , Oliva F , Maffulli N . Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature . Eur J Med Res . 2021 ; 26 ( 1 ): 118 . 10.1186/s40001-021-00593-9 34600573
Paprosky WG , Perona PG , Lawrence JM . Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation . J Arthroplasty . 1994 ; 9 ( 1 ): 33 – 44 . 10.1016/0883-5403(94)90135-x 8163974
Saklad M . Grading of patients for surgical procedures . Anesthesiol . 1941 ; 2 ( 3 ): 281 – 284 .
Weiss KS , McGivern KV , Suarez JC , Villa JM , Patel PD . Antibiotic cement spacer for isolated medial wall acetabular deficiency in the setting of infected hip arthroplasty . Arthroplast Today . 2018 ; 4 ( 4 ): 454 – 456 . 10.1016/j.artd.2018.02.008 30560174
Shahid M , Saunders T , Jeys L , Grimer R . The outcome of surgical treatment for peri-acetabular metastases . Bone Joint J . 2014 ; 96-B ( 1 ): 132 – 136 . 10.1302/0301-620X.96B1.31571 24395324
Sun W , Li J , Li Q , Li G , Cai Z . Clinical effectiveness of hemipelvic reconstruction using computer-aided custom-made prostheses after resection of malignant pelvic tumors . J Arthroplasty . 2011 ; 26 ( 8 ): 1508 – 1513 . 10.1016/j.arth.2011.02.018 21477973
Kostakos TA , Nayar SK , Alcock H , Savvidou O , Vlasis K , Papagelopoulos PJ . Acetabular reconstruction in oncological surgery: a systematic review and meta-analysis of implant survivorship and patient outcomes . Surg Oncol . 2021 ; 38 : 101635 . 10.1016/j.suronc.2021.101635 34365178
Marco RA , Sheth DS , Boland PJ , Wunder JS , Siegel JA , Healey JH . Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease . J Bone Joint Surg Am . 2000 ; 82-A ( 5 ): 642 – 651 . 10.2106/00004623-200005000-00005 10819275
Harrington KD . The management of acetabular insufficiency secondary to metastatic malignant disease . J Bone Joint Surg Am . 1981 ; 63-A ( 4 ): 653 – 664 . 6163784
Gusho CA , Chapman R , Blank AT . A modified Harrington technique for periacetabular reconstruction in advanced metastatic bone disease and a discussion of alternative treatment options . Orthop Rev (Pavia) . 2020 ; 12 ( 4 ): 9011 . 10.4081/or.2020.9011 33569159
Schneiderbauer MM , von Knoch M , Schleck CD , Harmsen WS , Sim FH , Scully SP . Patient survival after hip arthroplasty for metastatic disease of the hip . J Bone Joint Surg Am . 2004 ; 86-A ( 8 ): 1684 – 1689 . 10.2106/00004623-200408000-00011 15292415
Allan DG , Bell RS , Davis A , Langer F . Complex acetabular reconstruction for metastatic tumor . J Arthroplasty . 1995 ; 10 ( 3 ): 301 – 306 . 10.1016/s0883-5403(05)80178-0 7673908
Nilsson J , Gustafson P , Fornander P , Ornstein E . The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients . Acta Orthop Scand . 2000 ; 71 ( 6 ): 591 – 596 . 10.1080/000164700317362226 11145386
Walker RH . Pelvic reconstruction/total hip arthroplasty for metastatic acetabular insufficiency . Clin Orthop Relat Res . 1993 ; 294 : 170 – 175 . 8358910
Houdek MT , Ferguson PC , Abdel MP , et al. Comparison of porous tantalum acetabular implants and harrington reconstruction for metastatic disease of the acetabulum . J Bone Joint Surg Am . 2020 ; 102-A ( 14 ): 1239 – 1247 . 10.2106/JBJS.19.01189 32675673
McPherson EJ , Stavrakis AI , Chowdhry M , Curtin NL , Dipane MV , Crawford BM . Biphasic bone graft substitute in revision total hip arthroplasty with significant acetabular bone defects: a retrospective analysis . Bone Jt Open . 2022 ; 3 ( 12 ): 991 – 997 . 10.1302/2633-1462.312.BJO-2022-0094.R1 36545948