N° 003 - September / October 2019
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Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity
By C. HIPFL(1), C. PERKA(1), G.I. WASSILEW(2) in category
(1). Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany - (2). Department of Orthopaedics, Universitaetsmedizin Greifswald, Ferdinand-Sauerbruchstraße, 17475 Greifswald, Germany
The management of severe acetabular bone loss in revision total hip arthroplasty (THA) is technically demanding. In cases of major column defects with less than 50% host bone contact, adequate implant fixation with a hemispherical cup and screws alone is not feasible. Furthermore, in cases of pelvic discontinuity (PD) the inherent stability of the hemipelvis is compromised resulting in persistent micromotions across the acetabulum and subsequent implant loosening[1-5]. These complex situations have traditionally been managed with the use of ilioischial antiprotrusio cages. However, since there is no bone ingrowth into the cage, the screws or flanges eventually break, leading to high long-term failure rates[6-12].
Cup-cage reconstruction has evolved as a viable option to treat these challenging revision cases. This construct typically consists of a trabecular metal (TM) acetabular component (Zimmer Biomet, Warsaw, Indiana) fixed with multiple screws and an antiprotrusio cage placed over the cup. The cage provides initial stability to the cup to allow its bone ingrowth. The first reports on mid-term clinical outcomes of this technique in the management of severe acetabular bone deficiencies and pelvic discontinuity are promising[14-19].
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