RESUMEN
Introduction: One of the most common and effective treatments for end-stage hip osteoarthritis is total hip arthroplasty (THA). According to the WHO, 1.5 million, more than 500,000, and approximately 100,000 THAs are performed annually in the world, in the USA, and in Russia, respectively. The use of Burch-Schneider cages has progressively increased since their introduction in 1975, with more than 125,000 cages being implanted by 2006. This design for revision surgery remains valid today.The objectives were to conduct a retrospective analysis of anti-protrusion cages in revision THA and evaluate long-term functional results. Methods: Fifty-eight revision surgeries were performed at Botkin Hospital from 2003 to 2020 with anti-protrusion Burch-Schneider cages because of aseptic loosening of the acetabular component. The average age of the examined patients was 61.2 (±12.9) years. The maximum follow-up duration was 17 years. The average follow-up duration was 10.5 (±4.1) years. We used the functional Harris, WOMAC, SF-36, and FJS-12 scales to evaluate functional results. The patients were distributed into the following groups according to the Paprosky classification: 2C, 3A, and 3B. Results: Group 2C showed good functional results, with a Harris score of 87 (±6.9), an FJS-12 score of 63.2 (±4.8), a WOMAC score of 175 (±16.7), and an Oxford Hip score of 39.06 (±9.1). Group 3A also showed good functional scores, with a Harris score of 78 (±7.1), an FJS-12 score of 61.2 (±5.1), a WOMAC score of 168 (±17.1), and an Oxford Hip score of 42.12 (±8.7). Group 3B showed satisfactory functional results, with a Harris score of 70 (±5.9), an FJS-12 score of 58.9 (±4.4), a WOMAC score of 166 (±18.1), and an Oxford Hip score of 48.4 (±9.4).Among patients who underwent revision surgery using Burch-Schneider rings, 16 needed to undergo repeat revision surgery. Periprosthetic infection occurred in 5 patients, aseptic loosening in 7, and periprosthetic fracture in 3. Conclusions: The anti-protrusion Burch-Schneider system is a necessary and up-to-date element of THA and can be used with great efficacy in revision THA. Despite the rapid development of technologies and the appearance of new, highly efficient devices, there is still room for systems such as Burch-Schneider rings. However, there are relatively few indications for their use, with the main indications for the use of anti-protrusion systems being conditions related to bone defects of the acetabular roof and bone mass loss of the acetabular floor.
RESUMEN
BACKGROUND: Careful preoperative planning in revision cases with complex acetabular defects is crucial for optimal surgery outcome. However, in many cases, computed tomography (CT) scans cannot give a clear understanding of the pelvic destruction. Three-dimensional (3D) models-based on CT data can help surgeon in planning of complex acetabular reconstruction. MATERIALS AND METHODS: We used 3D plaster pelvic models in 17 revision cases. There were 5 patients with Paprosky II C acetabular defects, 2 patients with Paprosky IIIA defects, and 10 patients with Paprosky IIIB defects (3 patients among them with pelvic discontinuity). We used 3D printer and digital 3D models based on CT scan data for 3D models printing. In 3 cases with Paprosky IIIB defects, we implanted custom-made acetabular components with the porous coating, also printed on the 3D printer. RESULTS: In 14 cases, we used trabecular metal (TM) augments with TM cups. In 100% of cases, number and type of planned and used augments were same. In 9 (64.3%) cases, size of planned and used cups was same. In other cases, the difference was not >2 mm. CONCLUSIONS: Use of 3D plaster models for the revision hip arthroplasty planning with complex acetabular defects has shown high accuracy in the clear understanding of acetabular bone deficiency.