The Modified Harrington Procedure for Metastatic Peri-Acetabular Bone Lesion Using a Novel Highly Porous Titanium Revision Shell with Long Lever Arm Screw.

Background and Objectives: Peri-acetabular metastases often lead to significant pain and functional impairment. Surgical interventions, including the Harrington procedure, aim to address these challenges. This study evaluates a modified Harrington procedure using the MUTARS® PRS® (Pelvic Revision Shell) with an 8 mm fixation screw for severe acetabular defects resulting from metastatic lesions. Materials and Methods: Retrospective analysis of 12 patients treated between January 2020 and December 2023 was conducted. The procedure involved using the novel MUTARS® PRS® with an 8 mm in diameter dome screw (length 70-100 mm). Outcome measures included implant positioning changes, complication rates, functional outcomes, implant longevity, and patient survival. Radiological assessments were performed postoperatively, with follow-ups at 3, 6, 12 months, and annually thereafter. Results: Average follow-up was 15 ± 11 months, with 67% patient survival at 1 year and 44% at 2 years. Implant survivorship remained 100%. Harris Hip Score improved significantly from 37 ± 22 preoperatively to 75 ± 15 at the last follow-up. No revisions involving implant components were reported. Complications occurred in 5 of 12 patients. Overall, PRS® demonstrates effective osseous ingrowth, high primary stability, immediate full weight-bearing, and low complication rates. Conclusions: PRS® integrates facilitating osseous ingrowth for preferable long-term outcomes, while efficiently transmitting the weight-bearing load to the intact aspect of the pelvis using a long 8 mm lever screw, enhancing the primary stability of the construct. It proves to be an effective and reproducible technique for managing destructive metastatic lesions of the acetabulum and peri-acetabular region, even in irradiated bone.

Mouldable Collagen-Tricalciumphosphate Is a Safe Carrier for Local Antibiotics-Short-Term Results in Revision Hip Arthroplasty.

BACKGROUND: Improving local antibiotic delivery is a promising approach to improve infection control and potentially shorten systemic treatment in periprosthetic joint infection (PJI). This study investigates the use of an antibiotic-loaded, mouldable collagen-tricalciumphosphate composite in treatment of hip PJI. METHODS: 124 application cases in 79 patients were included from a referral centre; systemic adverse infects, local complications, and infection control were analysed. RESULTS: In most cases, either vancomycin or meropenem were used. Pathogens were previously known in 82 (66%) cases with polymicrobial infection in 20 (25%) patients. There were no cases of hypercalcaemia. Acute kidney injure was present in 14 (11%) cases. Chronic kidney failure persisted in two cases. During a mean follow-up of 12 (SD 9.3; range 3-35) months, implant survival was achieved in 73 (92%) patients; revision due to PJI was performed in 19 cases. CONCLUSION: Mouldable collagen-tricalciumphosphate composite bone substitute as a local antibiotic carrier in revision hip arthroplasty appears to be a valid option for local antibiotic delivery without systemic complications. Implant survival of 92% supports the hypothesis that local antibiotic therapy is an important component in the treatment of PJI.