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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2025, Number 2

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Acta Ortop Mex 2025; 39 (2)

Total hip arthroplasty revision surgery with migration of acetabular component to the subperitoneal space. Case report and literature review

Cornejo-Albán P, Ramos-Flores X, Peñaherrera-Carrillo C, Endara-Urresta F, Vaca-Pérez P

Language: Spanish
References: 41
Page: 108-116
PDF size: 468.10 Kb.


ABSTRACT

Introduction: revision surgery in total hip arthroplasty associated with wear and loosening of its components has become a routine procedure. Revision arthroplasty is widely exposed in the literature. However, cases presenting with loosening and intrapelvic migration of the acetabular component are less frequent. Clinical case: female, 82 years old, with no clinical history of importance, except for a total right hip arthroplasty cemented one month ago. The patient does not tolerate standing or sitting, and does not ambulate. MID: hip: presence of a healed wound of approximately 12 cm. Limited ranges of mobility not assessable due to pain. HHS 16 points and VAS 8/10, showing imaging studies showing intrapelvic medial migration of the acetabular component without lesion of the great vessels. Revision surgery was performed with removal of the acetabular and femoral components. Infection was ruled out using alpha-defensin. Subsequently, a bone allograft is placed in the acetabular defect, then metallic mesh over the allograft, and a tantalum wedge is placed to finally place an acetabular cup. Finally, a diaphyseal anchorage femoral stem was placed, a 28 mm femoral head with a double mobility system and reduction of prosthetic components with adequate stability with recovery of hip biomechanics. Conclusions: the different options exposed for treatment and the combination of techniques present advantages and disadvantages. Highly porous metal cups and augmentations showed satisfactory results to correct severe defects, as is the case described, with an improvement in HHS of 64 points and VAS of 8 points one year after surgery.


REFERENCES

  1. Bou Monsef J, Parekh A, Osmani F, Gonzalez M. Failed total hip arthroplasty. JBJS Rev. 2018; 6(11): e3. Available in: http://dx.doi.org/10.2106/JBJS.RVW.17.00140

  2. Jain S, Grogan RJ, Giannoudis PV. Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review. Hip Int. 2014; 24(2): 109-22. Available in: http://dx.doi.org/10.5301/hipint.5000101

  3. Baauw M, van Hooff ML, Spruit M. Current construct options for revision of large acetabular defects: A systematic review. JBJS Rev. 2016; 4(11). Available in: http://dx.doi.org/10.2106/JBJS.RVW.15.00119

  4. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994; 9(1): 33-44.

  5. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982; 64-B(1): 17-9. Available in: http://dx.doi.org/10.1302/0301-620x.64b1.7068713

  6. Howie DW, Neale SD, Haynes DR, Holubowycz OT, McGee MA, Solomon LB, et al. Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management. Inflammopharmacol. 2013; 21(6): 389-96. Available in: http://dx.doi.org/10.1007/s10787-013-0192-6

  7. Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty. prevention and treatment. J Arthroplasty. 2007; 22: 86-90.

  8. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009; 91(1): 128-33. Available in: http://dx.doi.org/10.2106/JBJS.H.00155

  9. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4): 780-5. Available in: http://dx.doi.org/10.2106/JBJS.F.00222

  10. Jafari SM, Coyle C, Mortazavi SMJ, Sharkey PF, Parvizi J. Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop Relat Res. 2010; 468(8): 2046-51. Available in: http://dx.doi.org/10.1007/s11999-010-1251-6

  11. Howie DW, Neale SD, Martin W, Costi K, Kane T, Stamenkov R, et al. Progression of periacetabular osteolytic lesions. J Bone Joint Surg Am. 2012; 94(16): e1171-6. Available in: http://dx.doi.org/10.2106/JBJS.K.00877

  12. Nieminen J, Pakarinen T-K, Laitinen M. Orthopaedic reconstruction of complex pelvic bone defects. Evaluation of various treatment methods. Scand J Surg. 2013; 102(1): 36-41. Available in: http://dx.doi.org/10.1177/145749691310200108

  13. Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS. Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg. 2019; 103(1): 1-13. Available in: http://dx.doi.org/10.1007/s12306-018-0539-7

  14. Maccauro G, Liuzza F, Scaramuzzo L, Milani A, Muratori F, Rossi B, et al. Percutaneous acetabuloplasty for metastatic acetabular lesions. BMC Musculoskelet Disord. 2008; 9(1): 66. Available in: http://dx.doi.org/10.1186/1471-2474-9-66

  15. Spinelli MS, Ziranu A, Piccioli A, Maccauro G. Surgical treatment of acetabular metastasis. Eur Rev Med Pharmacol Sci. 2016; 20(14): 3005-10.

  16. Fryhofer GW, Ramesh S, Sheth NP. Acetabular reconstruction in revision total hip arthroplasty. J Clin Orthop Trauma. 2020; 11(1): 22-8. Available in: http://dx.doi.org/10.1016/j.jcot.2019.11.004

  17. D'Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989; (243): 126-37. P

  18. Saleh KJ, Holtzman J, Gafni A, Saleh L, Jaroszynski G, Wong P, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001; 19(1): 50-6. Available in: http://dx.doi.org/10.1016/S0736-0266(00)00021-8

  19. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018; 33(5): 1309-14.e2. Available in: http://dx.doi.org/10.1016/j.arth.2018.02.078

  20. Reid C, Grobler G, Dower B. Revision total hip arthroplasty: addressing acetabular bone loss. SA Orthop J. 2012; 11: 34-46.

  21. Egawa H, Powers CC, Beykirch SE, Hopper RH Jr, Engh CA Jr, Engh CA. Can the volume of pelvic osteolysis be calculated without using computed tomography? Clin Orthop Relat Res. 2009; 467(1): 181-7. Available in: http://dx.doi.org/10.1007/s11999-008-0522-y

  22. Cahir JG, Toms AP, Marshall TJ, Wimhurst J, Nolan J. CT and MRI of hip arthroplasty. Clin Radiol. 2007; 62(12): 1163-71; discussion 1172-3. Available in: http://dx.doi.org/10.1016/j.crad.2007.04.018

  23. Martino D, Strigelli I, Cacciola V. Survivorship and clinical outcomes of custom triflange acetabular components in revision total hip arthroplasty: a systematic review. J Arthroplasty. 2019; 34: 2511-8.

  24. Sporer SM. How to do a revision total hip arthroplasty: revision of the acetabulum. Instr Course Lect. 2012; 61: 303-11.

  25. Slooff TJ, Schimmel JW, Burna P. Cemented fixation with bone grafts. Orthop Clin North Am. 1993; 24(4): 667-77. Available in: http://dx.doi.org/10.1016/s0030-5898(20)31847-2

  26. Schreurs BW, Bolder SB, Gardeniers JW, Verdonschot N, Slooff TJ, Veth RP. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up. J Bone Joint Surg Br. 2004; 86(4): 492-7.

  27. Gie GA, Linder L, Ling RS, Simon JP, Slooff TJ, Timperley AJ. Impacted cancellous allografts and cement for revision total hip arthroplasty. J Bone Joint Surg Br. 1993; 75(1): 14-21. Available in: http://dx.doi.org/10.1302/0301-620X.75B1.8421012

  28. Boldt JG, Dilawari P, Agarwal S, Drabu KJ. Revision total hip arthroplasty using impaction bone grafting with cemented nonpolished stems and Charnley cups. J Arthroplasty. 2001; 16(8): 943-52. Available in: http://dx.doi.org/10.1054/arth.2001.25559

  29. Comba F, Buttaro M, Pusso R, Piccaluga F. Acetabular reconstruction with impacted bone allografts and cemented acetabular components. A 2- to 13-year follow-up study of 142 aseptic revisions. J Bone Joint Surg Br. 2006; 88: 865-9.

  30. Buttaro MA, Comba F, Pusso R, Piccaluga F. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res. 2008; 466(10): 2482-90. Available in: http://dx.doi.org/10.1007/s11999-008-0442-x

  31. Garcia-Cimbrelo E, Cruz-Pardos A, Garcia-Rey E, Ortega-Chamarro J. The survival and fate of acetabular reconstruction with impaction grafting for large defects. Clin Orthop Relat Res. 2010; 468(12): 3304-13. Available in: http://dx.doi.org/10.1007/s11999-010-1395-4

  32. Bostrom MP, Lehman AP, Buly RL, Lyman S, Nestor BJ. Acetabular revision with the Contour antiprotrusio cage: 2- to 5-year followup: 2- to 5-year followup. Clin Orthop Relat Res. 2006; 453: 188-94. Available in: http://dx.doi.org/10.1097/01.blo.0000246533.37006.b0

  33. Gaiani L, Bertelli R, Palmonari M, Vicenzi G. Total hip arthroplasty revision in elderly people with cement and Burch-Schneider anti-protrusio cage. Chir Organi Mov. 2009; 93(1): 15-9. Available in: http://dx.doi.org/10.1007/s12306-009-0019-1

  34. Hsu C-C, Hsu C-H, Yen S-H, Wang J-W. Use of the Burch-Schneider cage and structural allografts in complex acetabular deficiency: 3- to 10-year follow up. Kaohsiung J Med Sci. 2015; 31(10): 540-7. Available in: http://dx.doi.org/10.1016/j.kjms.2015.08.001

  35. Jones L, Grammatopoulos G, Singer G. The Burch-Schneider cage: 9-year survival in Paprosky type 3 acetabular defects. clinical and radiological follow-up. Hip Int. 2012; 22: 28-34.

  36. Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res. 2000; 378(378): 155-68. Available in: http://dx.doi.org/10.1097/00003086-200009000-00025

  37. Okano K, Miyata N, Enomoto H, Osaki M, Shindo H. Revision with impacted bone allografts and the Kerboull cross plate for massive bone defect of the acetabulum. J Arthroplasty. 2010; 25(4): 594-9. Available in: http://dx.doi.org/10.1016/j.arth.2009.04.003

  38. Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P. A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplasty. 2012; 27(6): 1057-63.e1. Available in: http://dx.doi.org/10.1016/j.arth.2011.11.019

  39. Wegrzyn J, Pibarot V, Jacquel A, Carret J-P, Béjui-Hugues J, Guyen O. Acetabular reconstruction using a Kerboull cross-plate, structural allograft and cemented dual-mobility cup in revision THA at a minimum 5-year follow-up. J Arthroplasty. 2014; 29(2): 432-7. Available in: http://dx.doi.org/10.1016/j.arth.2013.05.030

  40. Regis D, Magnan B, Sandri A, Bartolozzi P. Long-term results of anti-protrusio cage and massive allografts for the management of periprosthetic acetabular bone loss. J Arthroplasty. 2008; 23: 826-32.

  41. Gill TJ, Sledge JB, Müller ME. The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty. Indications, principles and long-term results. J Bone Jt Surg Br. 1998; 80: 946-53.




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