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. 2021 Mar 6;22(1):9.
doi: 10.1186/s10195-021-00571-1.

Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

Loris Perticarini  1 , Stefano Marco Paolo Rossi  2 , Marta Medetti  3 , Francesco Benazzo  1   4
Affiliations

Clinical and radiological outcomes of acetabular revision surgery with trabecular titanium cups in Paprosky type II and III bone defects

Loris Perticarini et al. J Orthop Traumatol. .

Abstract

Background: This prospective study aims to evaluate the mid-term clinical outcomes and radiographic stability of two different types of cementless trabecular titanium acetabular components in total hip revision surgery.

Methods: Between December 2008 and February 2017, 104 cup revisions were performed using trabecular titanium revision cups. Mean age of patients was 70 (range 29-90; SD 11) years. The majority of revisions were performed for aseptic loosening (86 cases, 82.69%), but in all the other diagnoses (18 cases), a significant bone loss (Paprosky type II or III) was registered preoperatively. Bone defects were classified according to Paprosky acetabular classification. We observed 53 type II defects and 42 type III defects. Cups were chosen according to the type of defect.

Results: Average follow-up was 91 (range 24-146) months. Mean Harris Hip Score (HHS) improved from 43.7 (range 25-70; SD 9) preoperatively to 84.4 (range 46-99; SD 7.56) at last follow-up. One (1.05%) cup showed radiographic radiolucent lines inferior to 2 mm and was clinically asymptomatic. One (1.05%) cup was loose and showed periacetabular allograft reabsorption. Kaplan-Meier survivorship was assessed to be 88.54% (95% CI 80.18-93.52%) at 71 months, with failure of the cup for any reason as the endpoint.

Conclusion: Trabecular titanium revision cups showed good clinical and radiographic results at mid-term follow-up in Paprosky type II and III bone defects.

Level of evidence: Level IV prospective case series.

Keywords: Acetabular bone loss; Acetabular reconstruction; Revision total hip arthroplasty; Trabecular titanium cup.

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Conflict of interest statement

There are no competing interests to declare. F. Benazzo is a consultant and have a teaching contract with Lima-corporate. There are no competing interests for any of the other authors. The other authors have no disclosures.

Figures

Fig. 1
Fig. 1
a From top left to bottom right: Intraoperative finding of a IIIB Paprosky acetabular defect treated with Delta TT Revision cup and TT augment fixed with screws on the cranial fins; Delta TT revision Cup with augment and face changer useful to lateralize the hip rotation center by 5 mm and improve the inclination cup angle by 20°; Delta One TT with polar augment already fixed; trial face changers. b A detail of the modularity of the cups and how to assemble the different components
Fig. 2
Fig. 2
a Preoperative x-rays of bilateral cup aseptic loosening; b 9 years follow-up on right side with Delta TT Revision cup + augment and 8 years follow-up on left side using Delta One TT + face changer
Fig. 3
Fig. 3
a Preoperative x-rays of cup loosening at right side; b 9 years follow-up after hip revision with Delta TT Revision cup, face changer, and modular stem on right side; 4 years follow-up after THA on left side
Fig. 4
Fig. 4
Kaplan–Meier survivorship curve, showing a survivorship of 88.54% (95% CI 80.18–93.52%) at 91 months of follow-up
Fig. 5
Fig. 5
a On right side, Delta TT revision cup at 3 years of follow-up. On left side, preoperative x-rays showed cup loosening and bone defect; b 7 years follow-up on right side and 5 years follow-up on left side both with Delta TT revision cup, and augment and modular conical stems on left side
See this image and copyright information in PMC

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