Impaction bone grafting for contained acetabular defects in total hip arthroplasty.

BACKGROUND: Acetabular bone loss is a technical challenge in total hip arthroplasty (THA). This study sought to report the functional and radiological results of acetabular reconstruction using impaction bone grafting (IBG) in patients with acetabular bone deficiency undergoing primary or revision THA. METHODS: In this prospective study, full history taking, preoperative clinical and radiological evaluation, and preoperative planning and templating were performed. The Paprosky classification and the American Academy of Orthopaedic Surgeons classification were used to assess the acetabular deficiencies. Clinical outcomes were assessed utilizing the Harris hip score (HHS) and a 4-question satisfaction questionnaire. Graft incorporation was evaluated in the last follow-up X-rays. RESULTS: This study included 50 patients with a mean age of 46.7 ± 15.3 years. The THA was primary in 14 (28%) patients and revision in 36 (72%) patients. The mean HHS improved significantly from 28.8 ± 24.1 preoperatively to 76.6 ± 6.1, with a mean follow-up period of 23 months. Overall, 88% of patients were very satisfied. Complete radiological graft incorporation to host bone was achieved in 35 (70%) patients, and the remaining patients had partial incorporation. Complete graft incorporation was associated more frequently with primary THA, autografts, cementless cups, decreased defect size, and decreased graft layer thickness. CONCLUSIONS: IBG for acetabular reconstruction in THA can achieve excellent clinical and radiological outcomes with a low complication rate. LEVEL OF EVIDENCE: Level IV.

Medium-term outcome of the Libra® cemented versus cementless stems in primary dual mobility total hip arthroplasty.

INTRODUCTION: Despite the increasing use of cementless stems in total hip arthroplasty, the cemented stem has played a valuable role in the armamentarium of orthopedic surgeons. This study aims to compare two types of Libra® stems SERF, one cemented (Libra® C) and the other cementless hydroxyapatite coated (Libra® HA) that were conducted to analyze the medium-term outcome regarding their behavior and longevity. METHODS: This is a retrospective study for patients who received primary total hip arthroplasty with Dual Mobility (DM) articulation in the period between January 2014 to January 2020 with a minimum of two years follow-up. Two-hundred hips have been identified in 196 patients. One hundred forty-three Libra® cementless versus fifty-seven Libra cemented stems were implanted and the outcome of these stems is reported. All procedures were performed through the posterior approach and cemented stems were selected for elderly patients with wide medullary canals Dorr Type C. The indications for the index procedure were fractures, avascular necrosis, rheumatoid, and osteoarthritis. One hundred thirty-nine cementless DM cups were used while sixty-one hips had cemented Novae stick cups. Radiological evaluation for cup and stem positions, cement mantle, and radiolucent lines was performed, besides clinical function using the Harris Hip Score. RESULTS: The average age of patients was 60 ± 14.8. At the latest review, none of the cemented stems was revised or awaiting revision. One cementless stem was revised because of cortical perforation. Five intraoperative fractures were observed in the cementless group, but none of them needed revision or affected the stem stability. Readmission to theatre occurred in four patients to evacuate hematoma in two, a reduction of dislocation in one, and grafting bone lysis in one. CONCLUSION: Cemented stems have an important role in osteoporotic patients with wide medullary canals with excellent outcomes and minimal risk of fracture. LEVEL OF EVIDENCE: Level IV.

Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group.

BACKGROUND: Post-operative dislocation and reconstruction of acetabular defects are two challenging topics in revision Total Hip Arthroplasty (rTHA). Cemented Dual Mobility (DM) cups on top of Kerboull Cross and bone graft have been successfully employed to overcome these challenges. The cementless augmented DM cups were recently introduced. In this study medium term results of the augmented cementless DM Coptos cups are reported and compared to the established technique of cemented DM cups and Kerboull plate. MATERIAL AND METHODS: This is a retrospective analysis of data collected on patients who received rTHA using DM cups in the period between June 2015 and September 2020. Two groups of patients were identified. The first group received cementless augmented DM-cups (NOVAE® Coptos TH-SERF) (Coptos TH cup group). The second comparable group who had Kerboull ring (KE ring group) and cemented DM cups (NOVAE® STICK). Demographic data, surgical technique, functional and radiological outcome as well as complications during the follow-up visits are reported. RESULTS: Forty-two patients with a mean age at the time of revision 48.8 ± 13.6 years. 29 patients received Coptos TH DM-cup, while 13 patients had Bone Graft (BG), KE ring and cemented DM cups for acetabular reconstruction. Acetabular defects were Paprosky types IIB and IIC in 31 patients and IIIA and B in 11 patients. The follow-up was 52.8 ± 21 months (mean ± STD); and the mean Harris Hip Score (HHS) at last visit was 91 ± 5. Good stability of all cups was reported. Full integration of the impaction graft was observed in 94% of the Coptos and 92% of the KE groups. One of the Coptos cups was readjusted and one case of single dislocation was recorded in the KE group. None of the DM cups in both groups was revised or awaiting revision. CONCLUSION: Coptos TH cups achieve similar results to the cemented DM on KE ring at the medium term but long term outcome remains to be seen.