Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series
Background: Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a “second” rTHA with “custom-made acetabul...
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| Hauptverfasser: | , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
September 2020
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| In: |
HIP international
Year: 2020, Jahrgang: 30, Pages: 64-71 |
| ISSN: | 1724-6067 |
| DOI: | 10.1177/1120700020928247 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/1120700020928247 Verlag, kostenfrei, Volltext: https://journals.sagepub.com/doi/10.1177/1120700020928247 
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| Verfasserangaben: | Frank S. Fröschen, Thomas M. Randau, Gunnar T.R. Hischebeth, Nadine Gravius, Dieter C. Wirtz, Sascha Gravius and Sebastian G. Walter |
MARC
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| 520 | |a Background: Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a “second” rTHA with “custom-made acetabular components (CMACs)” after a previously failed reconstruction with CMACs. - Methods: 4 patients with severe acetabular bone loss (Paprosky Type IIIB), who required a second rTHA after a previously failed reconstruction with CMAC, due to prosthetic joint infection (PJI), were included in our retrospective study. All prostheses had been constructed on the basis of thin-layer computed-tomography scans of the pelvis. The second rTHA was considered unsuccessful in the event of PJI or aseptic loosening (AL) with need for renewed CMAC explantation. - Results: The treatment success rate after second rTHA with a CMAC was 50% (2 of 4). In the successful cases, the visual analogue scale (VAS) score and Harris Hip Score (HHS) after the second rTHA (VAS range 2-4; HHS range 45-58 points) did not differ from those after the first rTHA, before onset of symptoms (VAS: range 2-4; HHS: range 47-55 points). In the failed cases, the second CMACs needed to be explanted due to PJI, with renewed detection of previous pathogens. Patients with treatment failure of the second CMAC had required a higher number of revision surgeries after explantation of the first CMAC than patients with a successful outcome. - Conclusions: In patients with severe acetabular bone loss and previously failed rTHA with CMACs, repeat rTHA with a CMAC may be a solid treatment option for patients with an “uncomplicated” multi-stage procedure, i.e., without persisting infection after explantation of the original CMAC. While the outcome in terms of clinical function does not appear negatively affected by such a “second attempt,” the complication rate and risk of reinfection, nonetheless, is high. | ||
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