Fahri EMRE, Erkan Sabri ERTAŞ, Murat BOZKURT

The role of component positions in revision hip arthroplasty; Minimum 5-year follow-up

This study aimed to investigate the effect of distance between the femoral head and predicted hip rotation center on clinical and radiological survival of the acetabular implants (Jumbo cups and acetabular cages) retrospectively in patients who had revision hip arthroplasties. The retrospective study included a total of 52 consecutive patients (16 in acetabular cage group I, 36 in Jumbo cup group II). Radiological evaluation was performed by assessing the hip rotation center, polyethylene wear, lateral offset of the hip, and the migration of acetabular component on pelvis AP radiographs. Harris Hip Score (HHS) was used to assess the clinical evaluation at one, three, six, twelve months, and each year. The mean postoperative HHS at the last clinical assessment was 67.0±12.9 in group I and 68.2±11.9 in group II, respectively. The change in the hip rotation center did not affect the HSS scores between the groups (p>0.05), whereas acetabular cup migration and lateral offset comparison between groups were found statistically significant (p: 0.007). There was no significant correlation between lateral offset and acetabular implant migration (p>0.05), however, there was a negative correlation in comparison between lateral offset and polyethylene wear. Our study results suggest that both jumbo porous-coated acetabular components with screw fixation or reinforcement cages can be used in hips with notable bone loss. However, it is concluded that the shorter offset had higher liner wear which may contribute to a higher revision rate after revision hip arthroplasty.

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1. Yoshino K, Tsukeoka T, Tsuneizumi Y, et al. Revision total hip arthroplasty using a cementless cup supporter and iliac autograft: a minimum of 15-year follow-up. J arthroplasty. 2017;32:3495-501.
2. Regis D, Sandri A, Bonetti I, et al. A minimum of 10-year follow-up of the burch-schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplasty. 2012;27:1057e63.
3. Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of Jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg Am. 2013;95:543e8.
4. Kim YH. Acetabular cup revision. Hip Pelvis. 2017;29:155-8.
5. Makinen TJ, Kuzyk P, Safir OA, et al. Role of cages in revision arthroplasty of the acetabulum. J Bone Joint Surg Am. 2016;98:233e42.
6. Johnston RC, Brand RA, Crowninshield RD. Reconstruction of the hip. A mathe- matical approach to determine optimum geometric relationships. J Bone Joint Surg Am. 1979;61:639-52.
7. Park DK, Della Valle CJ, Quigley L, et al. Revision of the acetabular component without cement. A concise follow-up, at twenty to twenty-four years, of a previous report. J Bone Joint Surg Am. 2009;91:350-5.
8. Moon JK, Ryu J, Kim Y, et al. Acetabular revision arthroplasty using press-fitted jumbo cups: an average 10-year follow-up study. Arch Orthop Trauma Surg. 2019;139:1149-60.
9. Deirmengian GK, Zmistowski B, O’Neil JT, et al. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am. 2011;93:1842-52.
10. Wang CX, Huang ZD, Wu BJ, et al. Cup-cage solution for massive acetabular defects: a systematic review and meta-analysis. Orthop Surg. 2020;12:701-7.
11. Ilyas I, Alrumaih HA, Kashif S, et al. Revision of type III and type IVB acetabular defects with Burch-Schneider anti-protrusio cages. J Arthro- Plasty. 2015;30:259-64.
12. Symeonides PP, Petsatodes GE, Pournaras JD, et al. The effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years’ follow-up. J Arthroplasty. 2009;24:168-74.
13. Whaley AL, Berry DJ, Harmsen WS. Extra large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am, 2001;83:1352–7.
14. Telleria JJ, Gee AO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471:3725-30.
15. Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg. 1980;62-A :1059-65.
16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737-55.
17. Lachiewicz PF, Poon ED. Revision of a total hip arthroplasty with a Harris-Galante porous-coated acetabular component inserted without cement. A follow-up note on the results at five to twelve years. J Bone Joint Surg Am. 1998;80:980-4.
18. Tanzer M, Drucker D, Jasty M, et al. Revision of the ace- tabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg Am. 1992;74:987-94.
19. Silverton CD, Rosenberg AG, Sheinkop MB, et al. Revision of the acetabular component without cement after total hip arthroplasty. A follow-up note regarding results at seven to eleven years. J Bone Joint Surg Am. 1996;78:1366-70.
20. Jasty M. Jumbo cups and morsalized graft. Orthop Clin North Am. 1998;29:249-54.
21. MacDonald SJ, Krishnamurthy A, Bradford MS, et al. Acetabular transplants in revision total hip arthroplasty: when there are no alternatives. Orthop Trans. 1996;20:95.
22. Ilchmann T, Neher S, Maurer F, et al. Modes of failure a threaded acetabular cup: a radiographic study with EBRA of 42 revised cups. Int Orthop. 2007;31:211-6.
23. Meek RM, Michos J, Gregoris P, et al. Mid-term results and migration behaviour of a ti-alloy cemented stem. Int Orthop. 2002;26:356-60.
24. Karachalios T, Hartofilakidis G, Zacharakis N, et al. A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation. Clin Orthop Relat Res. 1993;296:140–7.
25. García-Rey E, García-Cimbrelo E. Abductor biomechanics clinically ımpact the total hip arthroplasty dislocation rate: a prospective long-term study. J Arthroplasty. 2016;31:484–90.
26. Robinson M, Bornstein L, Mennear B, et al. Effect of restoration of combined offset on stability of large head THA. Hip Int. 2012;22:248–53.
27. Dammerer D, Blum P, Putzer D, et al. Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study. Arch Orthop Trauma Surg. 2021;141:509-16.
28. Buttaro MA, de la Rosa DM, Comba F, et al. High failure rate with the GAP II ring and impacted allograft bone in severe acetabular defects. Clin Orthop Relat Res. 2012;470:3148-55.
29. Hosny HAH, El-Bakoury A, Fekry H, et al. Mid-term results of graft augmentation prosthesis II cage and impacted allograft bone in revision hip arthroplasty. J Arthroplasty. 2018;33:1487-93.
30. Asayama I, Chamnongkich S, Simpson KJ, et al. Reconstructed hip joint position and abductor muscle strength after total hip arthroplasty. J Arthroplasty. 2005;20:414–20.
31. Clement ND, S Patrick-Patel R, MacDonald D, et al. Total hip replacement: increasing femoral offset improves functional outcome. Arch Orthop Trauma Surg. 2016;136:1317-23.
32. Sakalkale DP, Sharkey PF, Eng K, et al. Effect of femoral component offset on polyethylene wear in total hip arthroplasty. Clin Orthop Relat Res. 2001;388:125-34.
33. Little NJ, Busch CA, Gallagher JA, et al. Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res. 2009;467:2895–900.