Does a Cemented Cage Improve Revision THA for Severe Acetabular DefectsReportar como inadecuado

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Clinical Orthopaedics and Related Research®

, Volume 469, Issue 2, pp 494–502

First Online: 21 September 2010DOI: 10.1007-s11999-010-1546-7

Cite this article as: Hansen, E., Shearer, D. & Ries, M.D. Clin Orthop Relat Res 2011 469: 494. doi:10.1007-s11999-010-1546-7


BackgroundEvidence suggests a growing incidence of revision total hip arthroplasty THA including a subset with large acetabular defects. Revision THA for severe acetabular bone loss is associated with a relatively high rate of mechanical failure.

Questions-purposesWe questioned whether cementing a cage to the reconstructed acetabular defect and pelvis would improve the rate of mechanical failure for patients with Type 3 defects Paprosky et al. with and without pelvic discontinuity in comparison to historical controls.

MethodsWe retrospectively collected data on 33 patients who underwent 35 revision THAs using an acetabular reconstruction cage cemented to morselized allograft and either structural allograft or trabecular metal augmentation for Type 3 defects in the presence n = 13 and absence n = 22 of pelvic discontinuity at a mean followup of 59 months range, 24–92 months. The primary outcome was mechanical failure, defined as revision of the acetabular reconstruction for aseptic loosening.

ResultsRevision surgery for mechanical failure occurred in four of the 13 patients with pelvic discontinuity and two of the 22 patients without discontinuity. Radiographic loosening occurred in one patient with and one patient without pelvic discontinuity. Seven of the 35 revisions were subsequently revised for deep infection all in patients who were immunocompromised.

ConclusionsCementing the cage to the pelvis can offer an advantage for treating severe acetabular defects. Trabecular metal augmentation appears to provide better initial mechanical stability than a structural allograft, but successful allograft reconstruction may restore bone stock.

Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One or more of the authors MDR is a consultant for Smith and Nephew.

Each author certifies that his institution either has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of California, San Francisco Medical Center, San Francisco, CA, USA.

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Autor: Erik Hansen - David Shearer - Michael D. Ries


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