Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty

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Abstract


The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design.

Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimüller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component.

Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery — 44 points, after 3 months after surgery — 65, after 6 months — 82. Quality of life was assessed according to the WOMAC scale: before surgery — 73 points, after 1 month after surgery — 54 points, after 3 months — 31, after 6 months — 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles.

Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.


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About the authors

Hovakim A. Aleksanyan

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Author for correspondence.
Email: hovakim1992@mail.ru
ORCID iD: 0000-0002-6909-6624

Russian Federation, 10, Priorov street, Moscow, 125299

traumatologist-orthopedist, post-graduate student

Hamlet A. Chragyan

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: chragyan@gmail.com

Russian Federation, 10, Priorov street, Moscow, 125299

MD, PhD, doctor

Sergey V. Kagramanov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: Kagramanov2001@mail.ru

Russian Federation, 10, Priorov street, Moscow, 125299

MD, PhD, Leading Researcher

Nikolay V. Zagorodniy

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: zagorodniy51@mail.ru

Russian Federation, 10, Priorov street, Moscow, 125299

RAS corresponding member, MD, PhD, professor, head. endoprosthetics department

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Supplementary files

Supplementary Files Action
1.
Fig. 1. X-ray of the right hip joint at the time of admission to the clinic in 1998

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2.
Fig. 2. X-ray of the right hip joint after revision arthroplasty, replacement of the acetabular component in 1998.

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3.
Fig. 3. X-ray of the left hip joint at the time of admission to the clinic for primary endoprosthetics in 2001

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4.
Fig. 4. X-ray of the left hip joint after primary endoprosthetics in 2001

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5.
Fig. 5. X-ray of the pelvis at the control in 2005

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6.
Fig. 6. X-ray of the pelvis upon admission to the clinic in 2007

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7.
Fig. 7. X-ray of the pelvis before revision arthroplasty of the left hip joint in 2012

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8.
Fig. 8. X-ray of the pelvis after revision arthroplasty of the left hip joint in 2012

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9.
Fig. 9. X-ray of the pelvis upon admission to the clinic for revision endoprosthetics of the right hip joint in 2019

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10.
Fig. 10. Computer-aided image of the affected part of the pelvis after treatment and cleansing from interference, soft tissues

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11.
Fig. 11. View of the pelvis model from different sides. Visualization of acetabular defects with an accuracy of 1 mm

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12.
Fig. 12. Development of a digital model of the implant: determining the orientation of the acetabular component and the direction of the screws, modeling the flanges

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13.
Fig. 13. View of the final implant model from different sides

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14.
Fig. 14. Radiograph after surgery: a strong primary fixation of the implant in the bone was achieved, the anatomical position of the acetabulum was restored

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Copyright (c) 2020 Aleksanyan H.A., Chragyan H.A., Kagramanov S.V., Zagorodniy N.V.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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