The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium

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Abstract

Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.

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The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

Lee Bayliss, David Culliford, A Monk … (2017)

Summary Background Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery. Methods We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. Findings We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3–95·9) and 20-year rate was 85·0% (83·2–86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8–96·4), and 20-year implant survival rate was 89·7% (87·5–91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9–39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Interpretation Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. Funding Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research.

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Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.

W G Paprosky, P G Perona, J M Lawrence (1994)

From 1982 to 1988, 147 cemented acetabular components were revised with cementless hemispheric press-fit components, with an average follow-up period of 5.7 years (range, 3-9 years). Acetabular defects were typed from 1 to 3 and reconstructed with a bulk or support allograft. Type 1 defects had bone lysis around cement anchor sites and required particulate graft. Type 2A and B defects displayed progressive bone loss superiorly and required particulate graft, femoral head bulk graft, or cup superiorization. Type 2C defects required medial wall repair with wafer femoral head graft. Type 3A and B defects demonstrated progressive amounts of superior rim deficiencies and were treated with structural distal femur or proximal tibia allograft. Six of the 147 components (4.0%), all type 3B, were considered radiographically and clinically unstable, warranting revision. Three of the six were revised. Moderate lateral allograft resorption was noted on radiographs, but host-graft union was confirmed at revision. Size, orientation, and method of fixation of the allografts play an important role in the integrity of structural allografts, while adequate remaining host-bone must be present to ensure bone ingrowth.

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Outcomes of dual mobility components in total hip arthroplasty

B. Darrith, P M Courtney, C Della Valle (2018)

Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship.

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Author and article information

Journal

Journal ID (nlm-ta): HSS J

Journal ID (iso-abbrev): HSS J

Journal ID (publisher-id): HSS

Journal ID (hwp): sphss

Title: HSS Journal

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 1556-3316

ISSN (Electronic): 1556-3324

Publication date (Electronic): 28 September 2021

Publication date (Print): February 2022

Publication date PMC-release: 28 September 2021

Volume: 18

Issue: 1 , Special Section: The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium

Pages: 8-41

Affiliations

[1 ]Hospital for Special Surgery, New York, NY, USA

[2 ]George Washington University School of Medicine & Health Sciences, Washington, DC, USA

[3 ]University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK

[4 ]Duke University Health System, Durham, NC, USA

[5 ]OrthoCarolina, Charlotte, NC, USA

[6 ]Royal North Shore Hospital, St. Leonards, NSW, Australia

[7 ]Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

[8 ]Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada

Author notes

[*]Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA. Email: sculcop@ 123456hss.edu

Article

Publisher ID: 10.1177_15563316211034850

DOI: 10.1177/15563316211034850

PMC ID: 8753540

PubMed ID: 35082557

SO-VID: 48f244aa-5778-4c3a-b901-dbb295f686f6

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This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 12 February 2021

Date revision received : 7 July 2021

Date accepted : 7 July 2021

Funding

Funded by: Stavros Niarchos Foundation, ;

Award ID: Grant

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: acetabular bone loss,revision total hip arthroplasty,acetabular component revision,consensus

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: acetabular bone loss, revision total hip arthroplasty, acetabular component revision, consensus

The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium

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Most cited references 269

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study

Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.

Outcomes of dual mobility components in total hip arthroplasty

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