Dataset Information

Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

ABSTRACT:

Background

Revision total hip arthroplasty in cases with severe acetabular bone loss is challenging. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been the treatment of choice. The current paper describes an impaction grafting into a mesh for uncontained defects in revision total hip arthroplasty.

Description of technique

After restoring containment with a mesh fixed with small fragment screws, defects were restored using impaction grafting combined with a cemented all-polyethylene cup.

Patients and methods

Fourteen consecutive acetabular impaction graftings were performed by two surgeons. All patients had a type 3B defect according to the Paprosky classification.

Results

No re-revisions or radiographic failure was detected in the early follow-up period.

Conclusion

Impaction grafting into a mesh is an interesting treatment option to restore bone in combined cavitary and segmental defects.

SUBMITTER: Buckup J

PROVIDER: S-EPMC3772160 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

Buckup Johannes J Salinas Emiliano Alvarez EA Valle Alejandro Gonzalez Della AG Boettner Friedrich F

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20130815 3

<h4>Background</h4>Revision total hip arthroplasty in cases with severe acetabular bone loss is challenging. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been the treatment of choice. The current paper describes an impaction grafting into a mesh for uncontained defects in revision total hip arthroplasty.<h4>Description of technique</h ...[more]

PMID: 24426876

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Project description:BACKGROUND: Surgical hip dislocation allows for a 360° view of the acetabulum and may facilitate a reduction in selected acetabular fractures. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification. DESCRIPTION OF TECHNIQUE: The procedure involves digastric trochanteric flip osteotomy and safe dislocation of the femoral head, preserving its vessels. T-type, transverse fractures alone or associated with posterior wall could be reduced with specific clamps and reduction adequacy can be judged by direct view. Anterior column fixation could be performed with one or two screws; the posterior column could be fixed with a single posterior plate or with two plates if a transverse fracture is associated with a posterior wall fracture. METHODS: Between 2005 and 2011, we used this approach selectively to manage those types of fractures; during the period in question, we treated 312 acetabular fractures surgically, of which 31 (10%) were treated using this approach. Patient demographic, injury, and surgical variables as well as complications were recorded. Outcomes were evaluated with the Merle d'Aubigné and Postel system. Radiographic outcome was scored according to Matta's criteria on postoperative radiographs (AP and Judet views). Minimum followup was 24 months (mean, 43 months; range, 24-87 months). RESULTS: Fracture reduction was defined as anatomic in 65% cases, imperfect in 16%, and poor in 19%. Mean Merle d'Aubigné score was 15 points (out of 18, with higher scores being better). Two patients developed symptomatic femoral head avascular necrosis. CONCLUSIONS: In complex cases, surgical dislocation presents several advantages; a single approach may reduce surgical time, permit direct intraarticular assessment, and facilitate screw placement closer to the articular surface. It also presents several limitations; some difficulties with bone-reduction clamp positioning, limited fixation of the anterior column, and a small risk of greater trochanter malunion.

Dataset Information

Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

Background

Description of technique

Patients and methods

Results

Conclusion

Publications

Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

Similar Datasets

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