Component migration is usually superomedially. Paprosky developed the classification evaluating patients. Acetabular defects were graded pre- operatively. Acetabular and Femoral Defect Classification* Acetabular Revision System . Paprosky W, Perona P, Lawrence J. Acetabular defect classification and. One commonly used classification is the Paprosky classification for femoral bone Type I femoral bone loss refers to a defect in which minimal . to more complex anatomic structures such as the acetabulum, the limitations of.
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Revision total hip arthroplasty: addressing acetabular bone loss
Longterm clinical outcomes following the use of synthetic hydroxyapatite and bone graft in impaction in revision hip arthroplasty. In these patients, nonsurgical treatment such as activity modification, ambulatory aids, and oral analgesics may be appropriate. A radiograph is shown in Figure A.
Acta Orthopaedica ; 80 classfiication Most reported series were performed for salvage of septic cases. Bone loss from 9am-5pm around rim, superomedial cup migration. Services on Demand Article. They concluded that ‘the literature is deficient in both long term follow up of larger series and in randomised controlled trials comparing aacetabular graft substitutes with allograft. Injury ddfects SS Glithero et al 26 report false negatives poor sensitivity in chronic peri-prosthetic infection.
Reconstruction of segmental defects during revision procedures of the acetabulum with the Burch-Schneider anti-protrusio cage. Ischial osteolysis is considered to be an indication of destruction of posterior support structures and is associated with type III defects.
Some success has been reported with acetabular anti-protrusio cages that span the defect and are secured to the ilium and ischium, combined with morcellised bone graft, but longterm results remain disappointing.
Type I defects have no significant bone loss. Preoperative Planning Preoperative planning is a critical classufication of any reconstructive hip surgery but is particularly important in revision surgery. Intraoperative decisions are based on findings when trial components are used; acetabulra, intraoperative findings can often be predicted by the preoperative AP radiograph of the pelvis when this classification system is used.
History and clinical assessment. Loss of bone of the supporting shell of femur. Historically, the most common indication for acetabular revision has been loosening of the acetabular component. Fresh allograft can be collected during primary arthroplasty procedures to be frozen in a bone bank, but this is not common practice in countries where there is a high incidence of communicable diseases.
Acetabulae suggests that, despite its shortcomings, it is one of the best options available to help surgeons anticipate and plan for findings at the time of revision surgery. Intraobserver reliability of the originators was moderate for both, clxssification the Paprosky classification being slightly more reliable. Restoring the optimal position of the acetabulum is important for providing the highest likelihood of hip stability. Pelvic discontinuity Pelvic discontinuity occurs when the superior and inferior aspects of the hemipelvis are separated by a fracture through both columns.
A current radiograph is shown in Figure Classificagion. J Bone Joint Surg Am. A survey of 27 Girdlestone hips. Periprosthetic bone loss of the acetabulum.
Revision using an ilioischial reconstruction ring acetabular component and structural corticocancellous graft. In a type IIIA defect there is a rim deficiency from 10 o’clock to 2 o’clock.
Femoral component failure was a more common reason for revision than acetabular component failure. Once the acetabular component has migrated superiorly by more than 2 or 3 cm type III defectthere is high risk of associated pelvic discontinuity because of the deficiency of the anterior and posterior columns at that level.
Figure Type 2A acetabular defect. The remaining bone is completely supportive. The medial teardrop is still present. The requirement of unusual implants or sizes is often identified by templating.
The classification system is based on the integrity of the teardrop, hip center, Kohler line, and ischium [ 11 ]. The acetabular rim and walls are intact and supportive without distortion. Chapter 89 Acetabular Reconstruction. Late onset pain is associated with aseptic loosening, low defectss infection, osteolysis or instability.
Classifications In Brief: Paprosky Classification of Acetabular Bone Loss
Revision arthroplasty with a fully coated cementless stem, cable wiring, and bone graft. Although these studies show that neither of actabular classification systems is perfect, both agree that some form of classification should be used to facilitate communicate between surgeons and to compare outcomes. The peripheral defects in types I and II are further divided by anatomic position: The saddle prosthesis for salvage of the destroyed acetabulum.
This group is sub-classified according to the location of the defect. Paprosky’s classification 7 is based on assessing the remaining host bone available to provide support for the acetabular component Table Acetavular and Figure 2. Angiography Angiography or CT angiography to identify the major pelvic arteries may be indicated in certain cases. A conventional extensile approach classifucation suffice in these cases and angiography is not required.
A comparison of radiographic and scintigraphic techniques to assess aseptic loosening of the acetabular component in a total hip replacement.
Revision arthroplasty with a modular, tapered stem and bone grafting of the diaphyseal fixation. The shoot-through lateral is particularly helpful for evaluating the posterior column, which is often obscured by the cup on other films.
The rim remains intact; however, it is enlarged superiorly to create an oval. In chronic discontinuity with no potential for healing, the defect is distracted. Three weeks later he dislocates the hip arising from the toilet seat. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial.