J Korean Hip Soc.  2011 Sep;23(3):213-220. 10.5371/jkhs.2011.23.3.213.

Revision Total Hip Arthroplasty Using Acetabular Reinforcement Ring: Midterm Follow-up Result

• Kwak SJ
• Chun YS
• Rhyu KH
• Huh DB
• Yoo MC
• Cho YJ

• KMID: 2014888
• DOI: http://doi.org/10.5371/jkhs.2011.23.3.213

Abstract

PURPOSE
To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring.
MATERIALS AND METHODS
Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years.
RESULTS
The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases.
CONCLUSION
Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.

Keyword

Acetabulum; Acetabular bone defect; Reinforcement ring; Revision total hip arthroplasty

MeSH Terms

Acetabulum
Arthroplasty
Bone Remodeling
Follow-Up Studies
Hip
Hip Dislocation
Humans
Reinforcement (Psychology)
Transplantation, Homologous
Transplants

Figure

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  Fig. 1 51-years-old male. (A) The extensive osteolysis on acetabulum and proximal femur was found at 9 years after primary total hip arthroplasty. (B) The structural allograft was placed to support superior segmental defect of acetabulum and Burch-Schneider antiprutrusio cage was used for the acetabular revision. (C) Incorporation between structural allograft and host acetabular bone was found at 5 years after revision surgery.

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  Fig. 2 61-years-old female. She had total hip arthroplasty at 9 years ago. (A) Revision arthroplasty have done using Müller ring with mixed bone graft. (B) Failure of revision total hip arthroplasty with Müller ring was found at 5 years from the surgery. The ring was placed with high abduction angle at revision surgery. (C) Bone quality of the acetabulum of the patient was poor due to radiation therapy on the pelvic area for the cervical cancer.

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  Fig. 3 54-years-old male. He had total hip arthroplasty at 6 years ago. (A) There was extensive osteolysis on the acetabulum. (B) The Ganz ring was well placed and (C) successful incorporation of grafted bone was found at 6 years after revision surgery.

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  Fig. 4 (A) 60-years-old female. He had total hip arthroplasty at 15 years ago. (B) The acetabular revision was done with Müller ring and mixed bone graft. (C) Stable cage fixation with successful bony incorporation was seen on the radiograph at 6 years after the surgery.

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