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      Comparative Study of Peripheral Rim Fixation Using Jumbo Cup in Revisional Hip Arthroplasty

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          Abstract

          Purpose

          It is challenging procedure to revise acetabular component in acetabulum with severe bone defect or deformity. The jumbo cup is good option for revisional arthroplasty in large bone defect. The purpose of this study is to compare the prognosis of revisional total hip arthroplasty using jumbo cup with peripheral rim fixation and no rim fixation.

          Materials and Methods

          We included the patients who had performed acetabular revisional total hip arthroplasty from January 2002 to March 2015 in our institute. Total of 51 hips (51 patients) were included. The mean follow up period was 51 months (range, 12 to 154 months) and mean age was 60.7 years (range, 30 to 81 years). We divided into two groups (peripheral rim fixation group and no rim fixation group) by anteroposterior and lateral plain radiograph. We compared survival rate, hip center change and clinical outcomes between two groups.

          Results

          There were 37 patients in peripheral rim fixation group and 14 patients in no rim fixation group. There was one patient who had aseptic loosening necessary to re-revision in rim fixation group and 3 patients in no rim fixation group. And one patient had superficial infection in rim fixation group and one patient had periprosthetic fracture in no rim fixation group. Survival rate was higher in the peripheral rim fixation group (97.3%) than no rim fixation group (78.6%, P=0.028)

          Conclusion

          Based on our findings, peripheral rim fixation might be recommended to improve short-term outcome after revision total hip arthroplasty using jumbo cup.

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          Most cited references17

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

          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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            Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty.

            Extra-large uncemented components provide several advantages for acetabular revision, but limited information is available on the results of their use. The purpose of this study was to evaluate, at a minimum of five years, the results associated with the use of an extra-large uncemented porous-coated component for acetabular revision in the presence of bone loss. Eighty-nine extra-large uncemented hemispherical acetabular components were used for revision after aseptic failure of a total hip arthroplasty in forty-six men and forty-three women (mean age at revision, fifty-nine years; range, thirty to eighty-three years). The revision implant (a Harris-Galante-I or II cup fixed with screws) had an outside diameter of > or = 66 mm in men and > or = 62 mm in women. Seventy-nine patients had a segmental or combined segmental and cavitary acetabular bone deficiency before the revision. Particulate bone graft was used in fifty-four hips and bulk bone graft, in nine. One patient died with the acetabular component intact and two patients were lost to follow-up within five years after the operation. At the time of the last follow--up, four acetabular components had been removed or revised again (two for aseptic loosening). All of the remaining patients were followed clinically for at least five years (mean, 7.2 years; range, 5.0 to 11.3 years). In the hips that were not revised again, only two sockets had definite radiographic evidence of loosening. All four of the sockets that loosened were in hips that had had combined cavitary and segmental bone loss preoperatively. In the hips that were not revised again, the mean modified Harris hip score increased from 56 points preoperatively to 83 points at the time of the most recent follow-up. The most frequent complication, dislocation of the hip, occurred in eleven patients. The probability of survival of the acetabular component at eight years was 93% (95% confidence interval, 85% to 100%) with removal for any reason as the end point, 98% (95% confidence interval, 92% to 100%) with revision for aseptic loosening as the end point, and 95% (95% confidence interval, 88% to 100%) with radiographic evidence of loosening or revision for aseptic loosening as the end point. This study demonstrates that extra-large uncemented components used for acetabular revision in the presence of bone loss perform very well and have a low rate of aseptic loosening at the time of intermediate-term follow-up.
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              Use of jumbo cups for revision of acetabulae with large bony defects.

              Several methods of treatment are available for acetabular revision associated with bone loss. Jumbo cups (minimum diameter of 62 mm in women, 66 mm in men, or 10 mm larger than the normal contralateral acetabulum) are often useful for large defects. The purpose of this study is to report a large jumbo cup series with an average 10-year follow-up. A total of 196 jumbo cups in 186 patients with a minimum of 2-year follow-up were available for review. Harris hip score improved from 44 preoperatively to 72 postoperatively. Survivorship was 98% at 4 years and 96% at 16 years. Five revisions and two resection arthroplasties were performed for failure. In conclusion, porous jumbo cup acetabular revision with supplemental screw fixation provides good to excellent intermediate- and long-term outcomes.
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                Author and article information

                Journal
                Hip Pelvis
                Hip Pelvis
                HP
                Hip & Pelvis
                Korean Hip Society
                2287-3260
                2287-3279
                March 2017
                06 March 2017
                : 29
                : 1
                : 24-29
                Affiliations
                Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
                [* ]Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
                []Department of Orthopaedic Surgery, The Catholic University of Korea, Yeoeuido St. Mary's Hospital, Seoul, Korea.
                Author notes
                Address reprint request to Young-Wook Lim, MD. Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Korea. TEL: +82-2-2258-2838, FAX: +82-2-535-9834, albire00@ 123456naver.com
                Article
                10.5371/hp.2017.29.1.24
                5352722
                29133559-76fb-4cd4-8a82-19c7dc493150
                Copyright © 2017 by Korean Hip Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 October 2016
                : 13 December 2016
                : 20 December 2016
                Categories
                Original Article

                revisional arthroplasty,jumbo cup,peripheral rim fixation,cementless

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