Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty
- 93 Downloads
In revision hip arthroplasty, custom-made implants are one option in patients with acetabular Paprosky III defects.
In a retrospective analysis, we identified 11 patients undergoing cup revision using a custom-made implant. The accuracy of the intended position of the implant was assessed on post-operative 3D CT and compared to the pre-operative 3D planning in terms of inclination, anteversion, and centre of rotation. In addition, the accuracy of post-operative plain radiographs for measuring implant position was evaluated in relation to the 3D CT standard.
We found a mean deviation between the planned and the final position of the custom-made acetabular implant on 3D CT of 3.6° ± 2.8° for inclination and of − 1.2° ± 7.0° for anteversion, respectively. Restoration of center of rotation succeeded with an accuracy of 0.3 mm ± 3.9 mm in the mediolateral (x) direction, − 1.1 mm ± 3.8 mm in the anteroposterior (y) direction, and 0.4 mm ± 3.2 mm in the craniocaudal (z) direction. The accuracy of the post-operative plain radiographs in measuring the position of the custom-made implant in relation to 3D CT was 1.1° ± 1.7° for implant inclination, − 2.6° ± 1.3° for anteversion and 1.3 mm ± 3.5 mm in the x-direction, and − 0.9 mm ± 3.8 mm in the z-direction for centre of rotation.
Custom-made acetabular implants can be positioned with good accuracy in Paprosky III defects according to the pre-operative planning. Plain radiographs are adequate for assessing implant position in routine follow-up.
KeywordsTotal hip arthroplasty Revision Custom-made implant Acetabular Paprosky III defects 3D CT
The support of Mr. S. Reuter during analysis of 3D-CT datasets is highly appreciated.
Compliance with ethical standards
The investigation was approved by the local medical ethics committee (No.: 17-415-101).
Conflict of interest
TR has received research support by DePuy International, Otto Bock Foundation, Deutsche Arthose Hilfe. TR’s research group “patientindividual joint replacement” is supported by the German Ministry of Education and Research (BMBF, grant number 01EZ0915). JG got research support by MSD, Novartis, De Puy, Otto Bock Foundation. Further financial support is from De Puy, Orthotech, Ozo-zours, Fischer Fussfit, Urban & Kemmler. JW is an employee for AQ implants. All other authors declare no potential conflict of interest.
- 3.Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM (2006) Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res 446:22–28. https://doi.org/10.1097/01.blo.0000214439.95268.59 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg Br 93:629–633. https://doi.org/10.1302/0301-620X.93B5.25893 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Bayraktar V, Weber M, von Kunow F, Zeman F, Craiovan B, Renkawitz T, Grifka J, Woerner M (2017) Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. Int Orthop 41:731–738. https://doi.org/10.1007/s00264-016-3240-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Choi HR, Anderson D, Foster S, Beal M, Lee JA, Barr C, Malchau H, McCarthy J, Kwon YM (2013) Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: Martell radiographic analysis. Int Orthop 37:1905–1910. https://doi.org/10.1007/s00264-013-2008-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Woerner M, Sendtner E, Springorum R, Craiovan B, Worlicek M, Renkawitz T, Grifka J, Weber M (2016) Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty. Acta Orthop:1–6. https://doi.org/10.3109/17453674.2015.1137182 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T (2015) The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop 39:2323–2333. https://doi.org/10.1007/s00264-015-2777-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Volpin A, Konan S, Biz C, Tansey RJ, Haddad FS (2018) Reconstruction of failed acetabular component in the presence of severe acetabular bone loss: a systematic review. Musculoskelet Surg. https://doi.org/10.1007/s12306-018-0539-7