• THA failure
• THA survival
• giant cup
• hip arthroplasty
• jumbo cup
• revision arthroplasty

• Humans
• Reoperation/methods
• Reoperation/statistics & numerical data
• Male
• Female
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/instrumentation
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Hip Prosthesis/adverse effects
• Registries
• Middle Aged
• Aged
• Prosthesis Failure
• Prosthesis Design
• Adult
• Aged, 80 and over
• Retrospective Studies
• Follow-Up Studies

• acetabulum defects
• porous metal augments
• titanium implants
• total hip arthroplasty
• total hip arthroplasty revision

• Humans
• Arthroplasty, Replacement, Hip/methods
• Osteotomy/methods
• Pelvic Bones/surgery
• Pelvic Bones/diagnostic imaging
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Reoperation/statistics & numerical data
• Blood Loss, Surgical/statistics & numerical data
• Treatment Outcome

• Acetabular bone defects
• Hip
• Hip arthroplasty revision

• Humans
• Acetabulum/diagnostic imaging
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/methods
• Female
• Male
• Aged
• Middle Aged
• Reoperation/statistics & numerical data
• Radiography
• Aged, 80 and over
• Reproducibility of Results
• Adult
• Retrospective Studies
• Observer Variation

• Adverse local tissue reaction
• Conversion total hip arthroplasty
• Hip resurfacing arthroplasty
• Patient reported outcome measures
• Total hip arthroplasty

• Custom-made acetabular implants
• Hip joint
• Revision total hip arthroplasty
• Standard acetabular implants
• Three-dimensional imaging

• 3D printing
• Acetabular bone loss
• Paprosky type III bone defect
• patient-specific implants
• pelvic discontinuity

• Humans
• Arthroplasty, Replacement, Hip/methods
• Female
• Male
• Printing, Three-Dimensional
• Middle Aged
• Aged
• Acetabulum/surgery
• Reoperation
• Hip Prosthesis
• Prosthesis Failure
• Prosthesis Design
• Adult
• Aged, 80 and over

• Acetabular reconstruction
• arthroplasty
• augmentation
• surgical technique

• Humans
• Arthroplasty, Replacement, Hip
• Hip Prosthesis
• Polyethylene
• Acetabulum/surgery
• Reoperation
• Follow-Up Studies
• Prosthesis Failure

• Acetabular reconstruction
• CFP
• Cemented THA
• Cementless THA
• Crowe classification
• Developmental dysplasia of the Hip (DDH)
• Mark III
• Osteoarthritis of the hip (OA)
• Outcome
• SP II
• Total hip arthroplasty (THA)

• Humans
• Male
• Female
• Young Adult
• Adult
• Middle Aged
• Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Hip Dislocation, Congenital/surgery
• Hip Dislocation, Congenital/complications
• Follow-Up Studies
• Developmental Dysplasia of the Hip/surgery
• Developmental Dysplasia of the Hip/complications
• Treatment Outcome
• Retrospective Studies

• Acetabular bone defects
• Cemented acetabular component
• Impaction bone grafting
• Metal mesh
• Revision total hip arthroplasty

Many studies have reported the clinical outcomes of a jumbo cup in revision total hip arthroplasty (rTHA) with acetabular bone defect. We conducted a systematic review to access the survivorship and clinical and radiological outcomes of a jumbo cup in rTHA.

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search from PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was performed with the keywords (“revision” OR “revision surgery” OR “revision arthroplasty”) AND (“total hip arthroplasty” OR “total hip replacement” OR “THA” OR “THR”) AND (“jumbo cup” OR “jumbo component” OR “extra-large cup” OR “extra-large component”). Studies reporting the clinical or radiological outcomes were included. The basic information and radiological and clinical results of these studies were extracted and summarized for analysis.

A total of 19 articles were included in the systematic review. The analysis of clinical results included 953 hips in 14 studies. The re-revision-free survivorship of the jumbo cup was 95.0% at a mean follow-up of 9.3 years. Dislocation, aseptic loosening, and periprosthetic joint infection were the top three complications with an incidence of 5.9%, 3.0%, and 2.1%, respectively. The postrevision hip center was relatively elevated 10.3 mm on average; the mean postoperative leg-length discrepancy was 5.4 mm.

A jumbo cup is a favorable option for acetabular bone defect reconstruction in rTHA with satisfying survivorship and acceptable complication rates.

• acetabular bone defect
• jumbo cup
• revision total hip arthroplasty
• rotation hip center
• survivorship

Bridging bone defects in revision total hip arthroplasty is a challenge to orthopedic surgeons. The eccentric revision cup is a progression of jumbo cup. Our aim is to confirm the optimal screw-hole positions of the eccentric revision cup by morphological measurements of three-dimensional pelvic reconstruction.

Eighty CT images were converted to virtual three-dimensional bones. After simulating the surgery procedure, all available screw holes were inserted with the screws in virtual. By measuring the length of the screw in the pelvic bone, we determined the rich bone stock area. Then the screw holes were designed according to the characteristics of bone stock distribution. The peripheral screw-hole cluster and inner screw-hole cluster were studied respectively.

For peripheral screw-hole cluster, five screw holes were evenly distributed between point A and point B in the thicker rim. For inner screw-hole cluster, screw hole 1 and screw hole 2 are the recommended inner screw holes.

The eccentric revision cup has inherited the strengths of jumbo cup besides several unique advantages, including using the peripheral screws enhancing primary stability; decreasing the shift of hip rotation center and restoring biomechanical function; reducing the risk of dislocation because of the smaller head-cup differences; increasing the contact area between the outer cup and the host bone while maintaining a normal inclination of the inner cup. In this study, we confirmed the optimal screw-hole positions of the eccentric revision cup by surgical simulation and morphological measurement. However, biomechanical tests are still being further explored.

• Bone defect
• Eccentric revision cup
• Revision
• Screw
• Total hip arthroplasty

With the development of radiology and three-dimensional (3D) printing technology, custom-made 3D-printed titanium augments have been more widely used. However, the radiological and clinical outcomes of custom-made augments lack reports. To better understand the clinical effect of using 3D-printed titanium augments and the significance of accurate placement, the aim of this study was to assess the outcomes when using custom-made 3D-printed titanium augments and to validate the idea that surgical simulation should be done before designing custom-made augments.

A retrospective review was conducted on 31 surgical simulations and revision total hip arthroplasties using custom-made 3D-printed titanium augments. The safe zone, cup position, and hip rotation center were measured on anteroposterior radiographs. Clinical outcomes were assessed with a mean 21.1 months of follow-up.

All patients were positioned within the safe zone, and none of the acetabular cups nor the custom-made augments had any evidence of migration at the latest follow-up. A strong correlation was found between the planned cup position and the postoperative position. The average vertical position of the center of rotation was significantly increased from 3.55 cm to 2.35 cm. The mean Harris Hip Score was increased from 40.81 preoperatively to 65.46 postoperatively. Complications included gait abnormality, groin pain, fracture of the greater trochanter, and partial palsy of the sciatic nerve. However, patient satisfaction reached 92.3%.

Surgical simulations help to design custom-made augments accurately and improve surgical plans. Acetabular components supported with custom-made 3D-printed augments is a useful method to bridge severe bone deficiencies. In this study, both the radiologic results and clinical outcomes were favorable.

Level 4.

The online version contains supplementary material available at 10.1186/s10195-022-00656-5.

• Bone defect
• Revision
• Three-dimensional printed augment
• Total hip arthroplasty

Acetabular defects are a challenging condition for surgeons in revision THA. A crucial aim is an anatomical restoration of the centre of rotation (COR) through grafts. The aim of this study was to determine the cup survival after biological restoration of acetabular defects in THA and the effect of Paprosky classification, age, BMI, and number of previous operations on cup survival. Retrospectively patients with a cup exchange and an impaction of cortico-cancellous or bulk grafts between 2009 and 2012 were included with a follow up with a minimum of 5 year. Implant failure was defined as radiographic loosening or explantation of the cup. The acetabular defect situation was classified to Paprosky. 82 patients (58 female 70.7%) were included. 26 patients were not available to contact. 56 patients (40 female 71.4%) remained for survival analysis with mean age of 75.6 ± 8 years. Survival of the cup after 5 years was 90% and after 7.8 years 88%. There was no difference in survival concerning defect classification, type of implant or graft, age, BMI, and number of previous operations. Patients on the follow up reached an HHS of 67.4 ± 19, a WOMAC Score of 33.4 ± 25.4 points and an unsatisfactory result in the SF-36. Impaction bone grafting of acetabular defects is a good option with satisfactory biomechanical results and survival for small defects. Predictive factors for cup survival could not be clarified in our study. So, the correct indication, knowing the limits of the methods and the correct choice of implant allow a defect-oriented approach and are decisive for the success of the operation.

Acetabular peri-prosthetic fractures are rare but their incidence is rising due to the increased prevalence of total hip arthroplasty, the increasing life expectancy and the growing functional demand of an ageing population, the incidence of primary total hip arthroplasty is increasing. They are either intra-operative or post-operative and have various aetiologies. Several factors such as implant stability, bone loss, remaining bone stock, fracture pattern, timing, age and co-morbidities of the patients must be considered for adequate treatment. To date, the literature on this subject has been sparse and no universally recognized treatment algorithm exists. Their rarity makes them a little-known entity and their surgical management represents a challenge for most orthopaedic surgeons. This review aims to present an update on epidemiology, the diagnostic work up, existing classification systems, surgical approaches and therapeutic options for acetabular peri-prosthetic fractures.

• Acetabular bone loss
• acetabular defects
• acetabular impaction graft
• metallic mesh
• revision total hip arthroplasty
• systematic review

• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Hip Prosthesis
• Humans
• Surgical Mesh
• United States

• custom-made acetabular implants
• hip joint
• revision total hip arthroplasty
• standard acetabular implants
• three-dimensional imaging

Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects. However, with the use of the jumbo cup, the center of the hip joint may become elevated relative to the primary acetabulum, and the diameter of the large cup is greater.

To study the height and the significance of the elevation of the hip joint center.

Eighty-eight patients matched the criteria for this condition and were included in the study. The center height of the hip joint was measured relative to the opposite normal hip joint. The diameter of the jumbo cup was measured and checked according to operation notes, and the diameter of the jumbo cup was measured with a prosthesis label. Then, the horizontal and vertical centers of rotation were measured on the surgical side and opposite side. The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.

Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm. The rotational center height delta of the renovated hip was 7.6 ± 5.6 mm, and there was an obvious difference between the two groups (P = 0.00). The difference in horizontal distance was 0.5 ± 5.1 mm (-11.5 -14.0 mm), and there was no obvious difference between the two groups (P = 0.38). According to the foreign standard, the rotational center height delta of the renovated hip was 7.5 ± 6.2 mm, and there was a significant difference between the two groups (P = 0.00). There was no obvious difference between the domestic and foreign standards (P > 0.05) between the two groups.

The application of the jumbo cup elevates the rotational center of the hip joint, but it is feasible and effective to use the jumbo cup.

• Hip revision surgery
• Jumbo cup
• Center of rotation
• Hip joint renovation
• Hip joint

Reconstruction of extensive acetabular bone defects is one of the most challenging problems encountered by arthroplasty surgeons. Triflange patient matched implants (PMI) offer the potential advantages of immediate, rigid fixation with a superior individualized fit. The purpose of this study was to evaluate the clinical and radiographic midterm results of PMI in extensive acetabular defect reconstruction.

The current prospectively designed retrospective review examined 13 consecutive patients (5 males and 8 females) with a mean age of 69 years undergoing revision hip arthroplasty with Paprosky type 3B acetabular defects reconstructed using PMI between October 2011 and December 2016. A successful result was defined as a postoperative increase in Harris hip score (HHS) of >20 points with a radiographically stable implant (assessed with hip X-rays) and no need for additional acetabular reconstruction.

Twelve out of the 13 patients in the study were available for follow-up with mean duration of 50 months. One patient died during the study period due to an unrelated cause. The mean HHS increased from 41 to 82 points. Eleven out of 12 acetabular components were well fixed and pelvic discontinuity healed in all patients.

Custom triflange PMI is an excellent option for management of complex and extensive acetabular defects with or without pelvic discontinuity.

• Custom triflange patient matched implant
• Extensive acetabular defects
• Pelvic discontinuity

Background

Persistent groin pain after total hip arthroplasty (THA) can result from iliopsoas impingement (IPI) on the acetabular rim. Controversy exists over the risks and benefits of tenotomy versus revision as a surgical solution. We report our limited experience with combined acetabular revision and partial iliopsoas tenotomy when other conservative treatments have failed.

Methodology

A total of eight patients revised for IPI by a single surgeon at a single institution were retrospectively reviewed after a minimum one-year follow-up. Preoperatively, all patients had prolonged groin pain for a mean of two years (range: 1-4 years) and had failed conservative treatment for at least six months. All patients underwent acetabular revision through a direct anterior approach (DAA) with partial psoas tendon release. No stems were revised. Dislocations, complications, and clinical outcomes are reported in this study.

Results

Of the eight patients, seven had a positive diagnostic challenge with an image-guided injection. All revised cups showed radiographic evidence of IPI with relative acetabular retroversion by either a cross-table lateral film or computed tomography scan. Preoperatively, the mean cup anteversion was 4 degrees (range: 0-9 degrees). Postoperatively, the mean cup anteversion was 19 degrees (range: 16-21 degrees). All cups were within the so-called safe zone. To avoid overstuffing, the mean cup size remained unchanged. There were no major postoperative complications. At a mean time to follow-up of 3.3 years, the mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 75 points (range: 32-100 points).

Conclusion

IPI may be effectively managed with combined acetabular revision and tenotomy. The challenges of implant placement and positioning may be aided with intraoperative imaging through a DAA THA.

• acetabular retroversion
• diagnostic injection
• direct anterior approach
• hip replacement
• iliopsoas impingement
• revision total hip arthroplasty
• total hip arthroplasty
• total hip replacement

• Spinopelvic alignment
• dislocation
• hip-spine
• pelvic tilt
• total hip arthroplasty

• Custom triflange component
• Paprosky classification
• Pelvic discontinuity
• Revision arthroplasty

• Acetabular revision
• Arthroplasty
• Furlong
• Jumbo cup

• acetabular deficiency
• complication
• custom triflange
• dislocation
• revision total hip arthroplasty
• survivorship

• Acetabulum/surgery
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Female
• Hip Prosthesis/adverse effects
• Humans
• Joint Dislocations/surgery
• Male
• Middle Aged
• Pelvis/surgery
• Postoperative Complications/etiology
• Postoperative Period
• Prosthesis Design
• Prosthesis Failure
• Plastic Surgery Procedures/adverse effects
• Reoperation/adverse effects
• Survivorship
• Treatment Outcome

• Complex hip arthroplasty
• Hip centre migration
• Impaction bone grafting
• Revision hip arthroplasty

• Acetabulum/surgery
• Adult
• Arthroplasty, Replacement, Hip/methods
• Bone Transplantation/methods
• Follow-Up Studies
• Hip Joint/diagnostic imaging
• Hip Joint/physiopathology
• Hip Joint/surgery
• Humans
• Male
• Radiography
• Reoperation
• Retrospective Studies
• Rotation

• Kerboull-type reinforcement device
• acetabular revision
• direct anterior approach
• total hip arthroplasty

• Acetabular revision
• Center of rotation
• Hip revision
• Jumbo cup

• Acetabular revision
• Jumbo cup
• Migration
• Wear

• Acetabular revision
• Custom flange acetabular component
• Pelvicdefects

• augment
• biomechanical reconstruction
• center of rotation
• head-cup difference
• jumbo cup
• revision total hip arthroplasty

• Allograft
• Arthroplasty
• Hip
• Irradiated
• Revision

• 3D print
• Acetabular bone loss
• custom
• osteolysis
• pelvic dissociation
• tri-flanged

• Level IV
• acetabular deficiencies
• bone substitute
• hydroxyapatite
• impaction graft
• prospective cohort study without control
• survivorship

• 3D printed
• Acetabular defects
• Bone loss
• Paprosky classification
• Patient specific acetabular component
• Pelvic discontinuity

• arthroplasty
• augments
• hip
• metal
• revision
• trabecular

• acetabular revision
• deep profile
• jumbo cups
• revision hip arthroplasty
• survivorship
• uncemented

This study is aimed at evaluating the fixation of trabecular metal wedges in patients who underwent revision of total hip arthroplasty with large acetabular bone defects.

The radiographs of 19 patients (21 hips), who underwent revision of total hip arthroplasty using trabecular metal wedges from September 2010 to December 2014 were evaluated. This study included only cases of Paprosky 3A and 3B. Preoperative and postoperative images were analyzed. Non-fixation of the implant was defined by the presence of angular variation of the component higher 10 degrees or displacement greater than 6 mm. Patients with follow-up times of less than 24 months or who did not attend the last two appointments were excluded from the study.

The mean follow-up time was 39.4 months (25–61). Fixation was achieved in all cases despite its complexity. There was only one case of dislocation that was treated with open reduction. One case developed infection, and was surgically approached on two occasions, with extensive debridement and intravenous antibiotics following protocol, with good evolution.

The implanted trabecular metal wedges showed excellent results in the short- and medium-term and may represent another option in the reconstruction of large acetabular defects, sometimes replacing bone reconstruction that uses bone tissue banks or autologous graft.

• Acetabulum
• Hip arthroplasty
• Prostheses and implants

• acetabular reconstruction revision
• autograft
• cementless cup
• cup supporter
• total hip arthroplasty

• acetabular bone deficiency
• outcomes
• revision arthroplasty
• structural allograft
• total hip arthroplasty

• Acetabula
• Hip Prosthesis Implantation
• Revision, Joint
• Surgical Revision
• Visual Analog Scale

High rates of mechanical failure have been reported in type III acetabular defects. Recently porous trabecular metal augments have been introduced with, excellent biomechanical characteristics and biocompatibility, allowing early stability and greater bone ingrowth. The aim of the study was to assess the short term clinical and radiological outcome of the trabecular metal augments.

We performed, 22 revision total hip arthroplasties (THA) and 6 primary THA (total 28) using trabecular metal augments to reconstruct acetabular defect between 2011 to 2015. Among 28 patients, 18 were males, 10 females. Mean age of patients was 61.21 years. Paprosky classification for acetabular bone defects was used. Eighteen cases were classified as grade 3 A and 10 cases as grade 3B. Hip center was calculated in each case preoperatively and compared postoperatively to check whether it has been brought down. Clinical outcome assessed using Harris hip score (HHS) and radiological outcomes as osteolysis in acetabular zones and osseointegration, according to Moore's criteria.

HHS improved from 58.00 to 86.20. Centre of rotation of hip joint corrected from 38.90 mm preoperatively to 23.85 mm postoperatively above the interteardrop line. Among 28 patients, 18 patients had three or more signs of osseointegration (Moore's criteria), during final follow up and 10 had one/two signs. No radiolucency, osteolysis, or loosening found during follow up radiographic examination.

Our study showed that trabecular metal augments were highly satisfactory in short term. However, long term study is required for better evaluation.

• Acetabular
• Bone defect
• Metal augment
• Total hip arthroplasty

It is challenging procedure to revise acetabular component in acetabulum with severe bone defect or deformity. The jumbo cup is good option for revisional arthroplasty in large bone defect. The purpose of this study is to compare the prognosis of revisional total hip arthroplasty using jumbo cup with peripheral rim fixation and no rim fixation.

We included the patients who had performed acetabular revisional total hip arthroplasty from January 2002 to March 2015 in our institute. Total of 51 hips (51 patients) were included. The mean follow up period was 51 months (range, 12 to 154 months) and mean age was 60.7 years (range, 30 to 81 years). We divided into two groups (peripheral rim fixation group and no rim fixation group) by anteroposterior and lateral plain radiograph. We compared survival rate, hip center change and clinical outcomes between two groups.

There were 37 patients in peripheral rim fixation group and 14 patients in no rim fixation group. There was one patient who had aseptic loosening necessary to re-revision in rim fixation group and 3 patients in no rim fixation group. And one patient had superficial infection in rim fixation group and one patient had periprosthetic fracture in no rim fixation group. Survival rate was higher in the peripheral rim fixation group (97.3%) than no rim fixation group (78.6%, P=0.028)

Based on our findings, peripheral rim fixation might be recommended to improve short-term outcome after revision total hip arthroplasty using jumbo cup.

• Cementless
• Jumbo cup
• Peripheral rim fixation
• Revisional arthroplasty

• acetabulum
• bone loss
• hip joint
• joint revision
• total hip arthroplasty

• Acetabulum/surgery
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/instrumentation
• Arthroplasty, Replacement, Hip/statistics & numerical data
• Bone Screws
• Female
• Follow-Up Studies
• Hip Prosthesis/statistics & numerical data
• Humans
• Joint Dislocations/surgery
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Prosthesis Failure
• Publications
• Radiography
• Reoperation
• Retrospective Studies
• Survival Analysis

• Cementless
• Midterm results
• Tantalum
• Total hip arthroplasty revision