Hip Pelvis.  2019 Jun;31(2):87-94. 10.5371/hp.2019.31.2.87.

Cup-Cage Construct Using Porous Cup with Burch-Schneider Cage in the Management of Complex Acetabular Fractures

• Malhotra R
• Gautam D

• KMID: 2448027
• DOI: http://doi.org/10.5371/hp.2019.31.2.87

Abstract

PURPOSE
Cup-cage construct technique was developed to address the massive acetabular defects during revision hip arthroplasty. Indications have extended to complex acetabular fractures with pelvic discontinuity necessitating acute total hip arthroplasty. However, its use is constrained in low socioeconomic countries due to non-availability of the original cages from Trabecular Metal Acetabular Revision System and high cost. We used a novel technique using the less expensive Burch-Schneider (BS) cage and Trabecular Metal Revision Shell (TMRS) to address the problem.
MATERIALS AND METHODS
We reviewed a consecutive series of 8 cases of acetabular fractures reconstructed using a "˜cup-cage construct' technique using a BS cage along with a TMRS. The mean age of the patients was 61.4 years. Patients were followed up for a mean period of 50.5 months (24 to 72 months). The patients were assessed clinically with Harris Hip Score and radiologically with serial X-rays.
RESULTS
All the patients were available at the latest follow up. The mean Harris Hip Score was 87.2. There was no radiological evidence of failure. One patient had dislocation two months following the surgery, which was treated by closed reduction and hip abduction brace. One patient developed an infection at 3 weeks necessitating debridement. The same patient had sciatic nerve palsy that recovered after 4 months.
CONCLUSION
This novel technique of the cup-cage construct seems to provide a stable construct at short to midterm follow-up. However, a long-term follow up would be required.

Keyword

Acetabular fractures; Acute total hip arthroplasty; Cup-cage construct

MeSH Terms

Acetabulum*
Arthroplasty
Arthroplasty, Replacement, Hip
Braces
Debridement
Dislocations
Follow-Up Studies
Hip
Humans
Sciatic Neuropathy

Figure

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  Fig. 1 (A) X-ray both hips with pelvis in anteroposterior view showing acetabular fracture in right side. (B) Computed tomogram scan of the pelvis in coronal section showing comminuted fracture of the acetabulum. Note the pelvic discontinuity. (C) Three-dimensional reconstruction computed tomogram showing the posterior aspect of the right hip. Note the comminuted fragments and near complete loss of bone in posterior column.

• 

  Fig. 2 Burch-Schneider cage.

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  Fig. 3 (A) Exposure of the acetabulum. White arrow showing the only acetabular bone that was intact. Only soft tissue seen in the acetabular bed due to bone loss. (B) The acetabulum filled up with autografts from the resected femoral head. (C) Impaction of the trabecular metal shell and fixed with multiple screws. (D) Placement of the Burch-Schneider cage onto the acetabular shell and fixed with screws. The lower flange is into the osteotomy made in the ischium. (E) A polyethylene liner cemented onto the cage.

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  Fig. 4 4. (A) Immediate post-operative X-ray of the same patient (in Fig. 1 and 3) showing reconstructed right hip with cup-cage construct technique. (B) Four-year follow up X-ray of the same patient showing the cup-cage components in situ. The fracture has healed and the component position is unchanged as compared to the immediate post-operative X-ray.

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