Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss

1. M. Abolghasemian, MD, Clinical Fellow1 ;
2. S. Tangsataporn, MD, Research Fellow1;
3. A. Sternheim, MD, Clinical Fellow1 ;
4. D. Backstein, MD, FRCSC, Associate Professor1;
5. O. Safir, MD, FRCSC, Assistant Professor1; and
6. A. E. Gross, MD, FRCSC, Professor1 

+Author Affiliations

1. 
   
   ¹Mount Sinai Hospital, University of Toronto, 600 University Street, Suite 476 (A), Toronto, Ontario M5G 1X5, Canada.

1. Correspondence should be sent to Dr M. Abolghasemian; e-mail:mn.abolghasemi@yahoo.com

Abstract

Trabecular metal (TM) augments are a relatively new option for reconstructing segmental bone loss during acetabular revision. We studied 34 failed hip replacements in 34 patients that were revised between October 2003 and March 2010 using a TM acetabular shell and one or two augments. The mean age of the patients at the time of surgery was 69.3 years (46 to 86) and the mean follow-up was 64.5 months (27 to 107). In all, 18 patients had a minor column defect, 14 had a major column defect, and two were associated with pelvic discontinuity. The hip centre of rotation was restored in 27 patients (79.4%). The Oxford hip score increased from a mean of 15.4 points (6 to 25) before revision to a mean of 37.7 (29 to 47) at the final follow-up. There were three aseptic loosenings of the construct, two of them in the patients with pelvic discontinuity. One septic loosening also occurred in a patient who had previously had an infected hip replacement. The augments remained stable in two of the failed hips. Whenever there was a loose acetabular component in contact with a stable augment, progressive metal debris shedding was evident on the serial radiographs. Complications included another deep infection treated without revision surgery. Good clinical and radiological results can be expected for bone-deficient acetabula treated by a TM cup and augment, but for pelvic discontinuities this might not be a reliable option.

Cite this article: Bone Joint J 2013;95-B:166–72.

Footnotes

• The authors would like to thank Mr M. McDonald, Mr D. Santa Ana and Mrs M. Santangelo for their contribution to the study.

  No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.