Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

Autor: Alter TD; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Hadley ML; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Couch CG; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Fruth KM; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Bedard NA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Perry KI; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Sierra RJ; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Lewallen DG; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2024 Sep; Vol. 39 (9S1), pp. S194-S202. Date of Electronic Publication: 2024 Apr 09.
DOI: 10.1016/j.arth.2024.03.071
Abstrakt: Background: Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship.
Methods: Between 2000 and 2012, 157 revision THAs were performed in cases with major acetabular defects (mainly Paprosky type IIIA and IIIB) utilizing porous tantalum cup-augment constructs. Pelvic discontinuity was noted intraoperatively in 17 hips (11%). Postoperative radiographs were evaluated at regular intervals for implant stability and radiolucent lines. There were 49 patients who had complete radiographic follow-up at 10 years or longer postsurgery.
Results: The 10-year survivorship free of revision of the cup-augment construct for aseptic loosening was 93%, free of any acetabular construct revision was 91%, free of any hip rerevision was 77%, and free of any reoperation was 75%. Pelvic discontinuity was associated with increased risk of reoperation (hazard ratio [HR] = 2.8), any hip rerevision (HR = 3.2), any cup-augment construct revision (HR = 11.8), and aseptic construct revision (HR = 10.0). Of unrevised cases with radiographs at 10 years, 4 hips showed radiographic loosening. Mean Harris hip scores improved from 47 preoperatively to 79 at 10 years.
Conclusions: Porous tantalum acetabular cup-augment constructs used in revision THA with severe acetabular bone loss provide excellent implant survivorship at 10 years when the acetabulum is intact. Due to lower survivorship of cup-augment constructs in cases of pelvic discontinuity, additional construct fixation or stabilization methods are recommended, when a discontinuity is present.
Level of Evidence: IV.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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