Management of Severe Acetabular Bone Loss in Hip Revision Surgery: Clinical and Radiographic Outcomes of Porous Metal Augmentation

João Dinis*, Inês Casais, José Ricardo Oliveira, Henrique Sousa, Pedro Seabra, Daniel Vilaverde, Mafalda Reis, Bárbara Choupina, André Sarmento and David Sá

Orthopedics and Traumatology Service, Centro Hospitalar de Vila Nova de Gaia/ Espinho, Portugal

*Corresponding Author: João Dinis, Orthopedics and Traumatology Service, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.

Received: March 09, 2023; Published: April 11, 2023

Abstract

Introduction: Restitution of the native center of rotation in revision hip surgery with extensive acetabular defects is a challenge and several solutions showed sub-optimal results in the past. The development of porous metal constructs, cups, and augments increased the possible solutions available for this problem and these materials have shown excellent outcomes in early-to-long-term studies.

The objective of this study was to evaluate the presence of early osteointegration signs in radiographic follow-ups of metal porous augments in acetabular revisions with large bone defects performed at our center.

Methods: We retrospectively evaluated 22 hips at a minimum follow-up of three years. The mean age was 72 ± 10 years (38-86 years). There were 10 males and 11 females, 15 right and 7 left hips. Based on Paprosky classification, five defects were classified as IIB, two as IIC, nine as IIIA and six as IIIB. The patients were clinically and radiographically evaluated at two weeks, four weeks, twelve weeks, six months and yearly after the surgery. Radiographic osteointegration signs were assessed according to Moore criteria.

Results: At a mean follow-up of 66.4 ± 4.29 months (range, 36-99 months), the HOOS score increased from 39.97 ± 20.24 to 74.50 ± 19. The Likert’s satisfaction and pain scales improved from 42.00 ± 12.81 and 59.00 ± 24.90 to 86.50 ± 19.54 and 25.00 ± 17.32, respectively. The final position of the hip center was in average 15.57 ± 9.72 mm lower (p < 0.001) and 4.07 ± 6.63 mm lateral (p < 0.05) compared to the preoperative hip center. In 17 hips (85%) the final hip centre was lower than preoperatively. Only one patient had a difference in sequentially measured cup-angles superior to 3°. The same patient was the only one with also radiolucent lines greater than 1 mm around the cup (zone 2 and 3 of DeLee and Charnley). However there were no radiolucent lines around the augments and the patient did not have relevant pain or impairment. A superolateral buttress was found in thirteen hips (65%), medial stress-shielding in four hips (20%), an inferomedial buttress in nine hips (45%) and radial bone ingrowth in one hip (5%). Heterotopic calcification was present in twelve hips (60%). One hip (5%) required an early re-operation because of acute periprosthetic infection.

Conclusion: All the augments showed good osteointegration as identified by absence of radiolucent lines. Porous metal augments with their modularity and form not only provide a reliable fixation, but also assist the surgeon to reconstitute the center of rotation of the hip in the desired position, improving abductor function and overall patient satisfaction. Porous metal augments constitute a proven solution for severe acetabular defects. This is a level IV study.

Keywords: Osteoarthritis; Osteoarthrosis; Pysical Therapist; Viscosupplmentation; Infiltrations; Corticosteroids

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Citation

Citation: João Dinis., et al. “Management of Severe Acetabular Bone Loss in Hip Revision Surgery: Clinical and Radiographic Outcomes of Porous Metal Augmentation”.Acta Scientific Orthopaedics 6.5 (2023): 40-47.

Copyright

Copyright: © 2023 João Dinis., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.