Positioning of custommade acetabular components at revision hip arthroplasty: do they really match as “a key and a lock”?

Abstract


Purposes are to determine 1) what frequency and what degree is of custom acetabular implants malposition in comparison with planned position, 2) what the reason of malposition is and 3) what the malposition consequences we can wait for. Patients and methods. The observation group included 20 patients (18 women and 2 men) with severe acetabular defects. Mean age of patients made up 53 (22-72) years. Position of the implants was compared with the parameters of preoperative planning using 5 postoperative CT indices (inclination, anteversion of semi- spherical part of the implant, spatial location of the rotation center in three axes). More than 10° deviation for inclination or anteversion and 5° dislocation of the rotation center in any axis was considered as a malposition of the component. Results. Only 5 of 20 constructions matched conditionally permissible limits by all the parameters. Most often excessive dislocation of the rotation center in lateral direction (10 cases) and excessive anteversion (9 cases) were observed. During 6 weeks follow up no complications related to the acetabular component position were recorded. Conclusion. It was shown that at revision arthroplasty with custom-made implants the probability of implant malposition as compared to the preoperative plan. The main reason could be the complexity of intraoperative orientation under conditions of abnormal hip anatomy. Malposition of the implants beyond the stated values did not result in complications within the early postoperative period. The longer follow up is required for the assessment of the long-term results.

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About the authors

Anton N. Kovalenko

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

Email: Tonnchik@yandex.ru
St. Petersburg, Russia
cand. med. sci., senior scientific worker, department of the loco-motor system and diseases diagnosis, RNIITO named after R.R. Vreden

R. M Tikhilov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

S. S Bilyk

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

I. I Shubnyakov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

M. A Cherkasov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

A. O Denisov

Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

St. Petersburg, Russia

References

  1. Labek G., Thaler M., Janda W. et al. Revision rates after total joint replacement: cumulative results from world- wide joint register datasets. J. Bone Joint. Surg. Br. 2011; 93 (3): 293-7. doi: 10.1302/0301-620X.93B3.25467.
  2. Paprosky W.G., Perona P.G., Lawrence J.M. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J. Arthroplasty. 1994; 9 (1): 33-44.
  3. Кавалерский Г.М., Мурылев В.Ю., Рукин Я.А. и др. Применение индивидуальных вертлужных компонентов при ревизионном эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2016; 22 (4): 114-21. doi: 10.21823/2311-2905-2016-22-4-114-121.
  4. Тихилов Р.М., Шубняков И.И., Коваленко А.Н. и др. Применение индивидуальной трехфланцевой конструкции при ревизионном эдопротезировании с нарушением целостности тазового кольца (клинический случай). Травматология и ортопедия России. 2016; (1): 108-16. doi: 10.21823/2311-2905-2016-0-1-108-116.
  5. Sheth N.P., Nelson C.L., Springer B.D. et al. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J. Am. Acad. Orthop. Surg. 2013; 21 (3): 128-39. doi: 10.5435/JAAOS-21-03-128.
  6. Abolghasemian M., Sadeghi Naini M., Tangsata- porn S. et al. Reconstruction of massive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Joint. J. 2014; 96-B (3): 319-24. doi: 10.1302/0301-620X.96B3.32850.
  7. Коваленко А.Н., Шубняков И.И., Билык С.С., Тихилов Р.М. Современные технологии лечения тяжелых костных дефектов в области вертлужной впадины: какие проблемы решают индивидуальные имплантаты? Политравма. 2017; 1: 72-81.
  8. Baauw M., van Hellemondt G.G., van Hooff M.L., Spruit M. The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthro- plasty of the hip. Bone Joint. J. 2015; 97-B (6): 780-5. doi: 10.1302/0301-620X.97B6.35129.
  9. Besl J.B., McKay N.D. A method for registration of 3-D shapes. IEEE Trans. Pattern. Anal. Mach. Intell. 1992; 14: 239-55.
  10. Moskal J.T., Capps S.G. Improving the accuracy of acetabular component orientation: avoiding malposition. J. Am. Acad. Orthop. Surg. 2010; 18 (5): 286-96.
  11. Cohen J. A power primer. Psychol. Bull. 1992; 112: 155-9.
  12. Коваленко А.Н., Шубняков И.И., Билык С.С. и др. Возможности современных технологий визуализации и моделирования в ортопедии и их роль в разработке индивидуальных конструкций в хирургии тазобедренного сустава. Вестник хирургии им. И.И. Грекова. 2016; 4: 46-52.
  13. Bosker B.H., Verheyen C.C., Horstmann W.G., Tulp N.J. Poor accuracy of freehand cup positioning during total hip arthroplasty. Arch. Orthop. Trauma Surg. 2007; 127 (5): 375-9. doi: 10.1007/s00402-007-0294-y.
  14. Barrack R.L., Krempec J.A., Clohisy J.C. et al. Accuracy of acetabular component position in hip arthroplasty. J. Bone Joint. Surg. Am. 2013; 95 (19): 1760-8. doi: 10.2106/ JBJS.L.01704.
  15. Choi H.R., Anderson D., Foster S. et al. Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: martell radiographic analysis. Int. Orthop. 2013; 37: 1905-10. doi: 10.1007/s00264-013-2008-0.
  16. Wasterlain A.S., Buza J.A., Thakkar S.C. et al. Navigation and robotics in total hip arthroplasty. JBJS Rev. 2017; 5 (3). pii: 01874474-201703000-00005. doi: 10.2106/JBJS. RVW.16.00046.
  17. Sugano N. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty. Clin. Orthop. Surg. 2013; 5 (1): 1-9. doi: 10.4055/cios.2013.5.1.1.

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