Fatigue Failure of the GAP Ring

doi:10.1016/j.arth.2006.12.108

The Journal of Arthroplasty

Volume 22, Issue 5, August 2007, Pages 711-714

https://doi.org/10.1016/j.arth.2006.12.108 Get rights and content

Abstract

This study reports the results and early failures using the Graft Augmentation Prosthesis ring in the reconstruction of acetabular defects encountered during total hip arthroplasty. Seventeen consecutive Graft Augmentation Prosthesis rings were used during 7 complex primary and 10 revision hip arthroplasties. Five patients died during the follow-up period. Of the remaining 12 patients, 7 had been revised at an average of 5 years follow-up. Five cases were revised because of fatigue failure of the implant associated with allograft resorption. Two cases were revised for recurrent dislocations. Because of this high mechanical failure rate (5 of 12 cases at only 5 years follow-up), we have abandoned this device in favor of implants with more mechanical strength.

Section snippets

Materials and Methods

Between 1996 and 1999, 17 consecutive GAP reconstruction rings were used for acetabular reconstruction during a total hip arthroplasty at our institution. There were 13 male and 4 female patients. The average age of the patient at the time of surgery was 66 years (range, 47-82 years). The average weight was 165 lb (range, 115-210 lb), and the average height was 65 in (range, 53-71 in). There were 7 complex primary total hip arthroplasties and 10 revision total hip arthroplasties. The underlying

Results

Five patients died during the study period, all with well-functioning hips. The follow-up period for the patients that died was an average of 2 years (range, 6 months-3 years). Of the remaining cases, the minimum follow-up was 5 years. The average follow-up was 6.5 years (range, 5-8 years).

The average preoperative Harris hip score was 38 points (range, 28-65), which after surgery improved to an average of 91 points (range, 68-100) of the surviving implants. There were no immediate postoperative

Discussion

A variety of surgical techniques can be used to reconstruct severe bone loss of the acetabulum. Large hemispherical acetabular components or “jumbo” cups can give satisfactory results in most of the cases [3]. However, with more severe bone deficiency or less than 50% host bone, cases may require alternative reconstruction options including bulk allografts with hemispherical cups 4, 5, oblong acetabular components [6], trabecular metal augments 16, 17, or custom triflange components [7].

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Cited by (16)

Mid-term Follow-up of the Direct Anterior Approach in Acetabular Revision Hip Arthroplasty Using a Reconstruction Cage With Impaction Grafting
2020, Journal of Arthroplasty
Citation Excerpt :
Vertical and horizontal acetabular migration was assessed by measuring the vertical distance from the center of the cup to the inter-teardrop line and the horizontal distance from the center of the cup to the ipsilateral teardrop [18]. A radiologic failure was defined as: (1) cage migration of greater than 5 mm in the horizontal or vertical plane [16], (2) progressive radiolucency, and (3) evidence of a broken screw or flange at the latest follow-up [19–21]. Failure was defined as implant revision or removal for any reason.
Severe acetabular bone loss is often treated with reconstruction cages and impaction grafting using allograft bone. Accurate implant positioning is crucial for successful clinical and radiological outcomes. The direct anterior approach (DAA) is a standard approach for primary total hip arthroplasty (THA) that is being used more frequently for revision THA. The aim of this study was to report midterm clinical and radiological outcomes of acetabular revision arthroplasty using the DAA to address large acetabular defects by using a reconstruction cage and impaction grafting.
Acetabular cup revisions were performed in 64 patients (64 hips) with severe acetabular bone loss. All patients received reconstruction cages with impaction grafting via the DAA. The stem was also revised in 22 patients. Complications, radiological, and functional outcomes were assessed.
Six of the 64 patients were revised at a mean follow-up of 27.6 months (range, 11-84 months), two each for implant failure, infection, and recurrent dislocation. One hip showed the radiological failure of the implant, but the patient was asymptomatic and was not revised. The median Western Ontario McMasters Osteoarthritis Score (WOMAC) for the cohort overall improved significantly (P < .01) by the latest follow-up compared with preoperative scores.
Good midterm outcomes can be obtained with the DAA for acetabular cup revisions done to address severe acetabular bone loss by using reconstruction cages and impaction grafting. The number of complications was within the expected range for this type of revision procedure at midterm follow-up, and dislocation rates were low.
Mid-Term Results of Graft Augmentation Prosthesis II Cage and Impacted Allograft Bone in Revision Hip Arthroplasty
2018, Journal of Arthroplasty
Citation Excerpt :
Previously, 2 studies have reported unfavorable results with early failures using the GAP cage [2,36]. In their series of 12 patients (5 primary and 7 revision THA), Duffy et al [2] reported an early failure of the GAP reinforcement ring. Despite not including patients with more severe bone defects who had pelvic discontinuity (mainly patients with American Academy of Orthopaedic Surgeons Classification (AAOS) type II and III acetabular defects), they encountered mechanical failure of the implant in 5 of their 7 revision patients (71%).
Several techniques have been described for management of severe acetabular bone defects during revision hip surgery including reconstructive cages. The purpose of this study is to analyze the survival and the mid-term clinical and radiological outcome using the Graft Augmentation Prosthesis (GAP II cage) (Stryker Orthopaedics, Mahwah, NJ) in addition to impaction grafting for acetabular defects in revision hip surgery.
This is a retrospective review of all patients who underwent acetabular revision hip replacement using GAP II cage and impaction bone grafting between 2009 and 2013 at our institution. Twenty-six patients were included with a mean age of 71 years (49-91). According to Paprosky classification, 2 patients had type IIB defect, 4 had type IIC, and 12 had type IIIA, while 8 suffered from type IIIB defect. The clinical outcome was assessed using Oxford Hip Score. Plain radiographs were used to assess preoperative bone loss, postoperative implant migration, and the incorporation of the bone graft to host bone.
The average Oxford Hip Score improved from 11.3 (2-22) preoperatively to 32.2 (20-48) postoperatively. The revision free survivorship of this construct was 100% at mean follow-up of 49 months (30-78). Three hips had radiological failure of the implant with no clinical consequences.
The use of GAP II cage with impaction bone grafting to reconstruct severe acetabular defects had encouraging mid-term results with low failure rate. Graft incorporation with restoration of bone stock may be beneficial should further revision surgery be needed.
Acetabular metal backed fatigue due to severe wear before revision
2009, Engineering Failure Analysis
The polymer UHMWPE is widely applied as bearing element at acetabular side in total hip arthroplasty. In some designs, a metal backed is placed between the polymer and bone. Today, wear of the polymer is the major cause of revisions. In some extreme cases, the metallic cephalic component and the metal backed experience contact wear promoting wear debris, which has catastrophic consequences. In this paper, it was analyzed a retrieved acetabular component of total hip arthroplasty re-revised due to metal backed rupture after gross metal wear. Failure analysis shown fatigue of the metal backed. To simulate the stress distribution over the metal backed and polymer liner, a finite element analysis was performed taking account metal backed wall reduction due to wear. It was observed that the decrease in the metal backed thickness increase stresses at the metal/polymer interface and the stresses which enhance polymer wear. It was also observed that wear produces a change of the location of maximum stress, from the contact periphery to the middle section of the hemispherical wall. This change promotes failure due to bending of the metal backed. Revision of metal backed shall be always made when metal backed wear is observed, even when it is well fixed in the bone.
Evaluation results of using GAP II acetabular cage for acetabulum in revision total hip arthroplasty
2022, Medicine (United States)
Lyophilized Human Bone Allograft as an Antibiotic Carrier: An In Vitro and In Vivo Study
2022, Antibiotics
Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study
2021, Archives of Orthopaedic and Trauma Surgery

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Original ArticleFatigue Failure of the GAP Ring

Abstract

Section snippets

Materials and Methods

Results

Discussion

Orthop Clin North Am

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

Ten years of experience with porous acetabular components for revision surgery

Clin Orthop

Original Article
Fatigue Failure of the GAP Ring