The Use of a Trabecular Metal Acetabular Component and Trabecular Metal Augment for Severe Acetabular Defects

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Abstract

Stable acetabular fixation cannot be reliably achieved with the use of a hemispherical porous coated component alone in patients with a Paprosky type IIIa defect. The purpose of the present study was to determine the short-term results of a tantalum porous coated hemispherical acetabular component supported with a modular tantalum augment in Paprosky type IIIa defects. A total of 28 patients (28 hips) were treated for a type IIIa acetabular defect between 2001 and 2003 with the use of a trabecular metal acetabular component supported with a modular, superiorly placed trabecular metal augment. At an average of 3.1 years follow-up, 1 patient required rerevision for recurrent instability. The remaining hips remain radiographically stable. Clinically, the patients' modified Postel Merle d'Aubigne score improved from 6.8 preoperatively to 10.6 postoperatively. The use of a trabecular metal acetabular component with a superiorly placed trabecular metal augment demonstrates encouraging short-term results for Paprosky type IIIa acetabular defects.

Section snippets

Materials and Methods

We retrospectively reviewed the clinical records and radiographs of all patients who had an acetabular revision using a trabecular metal acetabular component with a modular acetabular augment (Zimmer, Warsaw, Ind) at Central Dupage Hospital (Winfield, Ill) from January 2001 to December 2003. Patients were identified from operating room database retrieval system using standard current procedural terminology codes for revision THA. We obtained prior institutional review board approval.

Results

A total of 2 patients required the use of a walker, and 6 patients required the use of a cane, and 20 patients walked without support for more than 6 blocks. There were 25 patients who had no pain or mild pain and 3 patients who had moderate pain. The modified Postel Merle d'Aubigne scores improved from an average of 6.8 preoperatively to 10.6 postoperatively.

One patient with a type IIIa defect required acetabular rerevision to a constrained liner for postoperative instability. None of the

Discussion

Acetabular revision with extensive bone loss is challenging and technically demanding. Successful long-term results depend heavily on achieving intraoperative stability of the acetabular shell. Most acetabular revisions are associated with some degree of bone loss. The extent of the bone loss and osteolysis demonstrated on plain radiographs is often underestimated. Therefore, the surgeon must be comfortable with alternative surgical options when unexpected amounts of bone loss are encountered.

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