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
A comparison of the reliability and validity of bone stock loss classification systems used for revision hip surgery. Which acetabular bone defect classification and treatment option best describes this scenario?
How important is this topic clqssification clinical practice? Reconstruction of severe acetabular defects with associated pelvic discontinuity is a challenging problem. The majority of acetabular revisions can be performed with an uncemented hemispherical cup.
Acetabular Reconstruction: Classification of Bone Defects and Treatment Options
The number of revisions required for periprosthetic fractures was higher than that for deep infections. Numerous techniques have been described to address acetabular deficiencies. The rim is distorted but the columns are intact and supportive. There is superior migration of the component by more than 2 cm. Acetabular component migration due to bone loss will affect the biomechanics of the hip.
L8 – 10 years in practice. Bone loss from 9am-5pm around rim, superomedial cup migration. As this handy tool becomes more cost-effective and readily available, it is likely to play an increasing role in pre-operative planning of acetabular reconstruction in the future.
Acetabular component failure was a more common reason for revision than deep infection. During surgery, stable implant fixation is required to obtain a good long-term clinical result.
In another study, Gozzard et al. Loss of bone of the supporting shell of femur. Subsidence of the stem after impaction bone grafting for revision hip replacement using irradiated bone. An all tantalum revision cup can also be used and a polyethylene liner cemented into the shell. The shoot-through lateral is particularly helpful for evaluating the posterior column, which is often caetabular by the cup on other films. Conversion to arthroplasty should defecys be performed if arthrodesis is more than 15 years old.
Intraobserver reliability of the acetbaular was moderate for both, with the Paprosky classification being slightly more reliable. Development, test reliability and validation of a classification for revision hip arthroplasty.
This chapter will discuss the two most popular classification systems used to describe acetabular bone defects. Impaction bone grafting of the acetabulum at hip revision using a mix of bone chips and a biphasic porous ceramic bone graft substitute. An acute discontinuity has the potential for healing, and the fracture is bone grafted and compressed. Type 2B defects are characterized by a deficient superior dome, allowing for superior and lateral component migration owing to the lack of a lateral stabilizing ckassification, normally provided by the lateral margin of the superior dome.
Superior structural support can be provided by bulk allograft or by metal augmentation. It should be a long-term solution. Acetabular defect classification and surgical reconstruction in revision arthroplasty: The authors did comment, however, that similar results were published at the time for uncemented revisions.
Additional screw holes defcets be created in the tantalum revision cup using a high speed burr if required. Pre-operative planning Plain radiographs Plain radiography is the most common, most cost-effective and possibly the most useful investigation for preoperative planning. Cementless acetabular fixation at fifteen years. Some old techniques have stood the test of time and should not be forgotten. Conclusions and Uses The development of a reliable, valid, and universally accepted classification for acetabular bone loss in revision THA continues to problematic.
Three radiographic criteria are assessed on the AP radiograph for pre-operative classification according to the Paprosky system: Porous-ingrowth revision acetabular implants secured with peripheral screws: The superior rim is absent; however, the column remains fully supportive. Loss of endosteal bone with intact cortical shell.
In most patients, the defect can be treated with particulate allograft because the remaining superior rim provides a buttress for containment of the allograft. The classification does not clearly define moderate or severe osteolysis. Revision of a cemented acetabular component to a cementless acetabular component.
Projections of primary and revision hip and knee arthroplasty in the United States from to The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. Severe bone loss is evident.
The requirement of unusual implants or sizes is often identified by templating. The classification serves as a guide only and it is important that the surgeon appreciates its limitations. Acta Orthopaedica ; 80 2: Type 2A defects are oval enlargements of the acetabulum caused by superior bone lysis; however, the superior rim of the acetabulum is intact Fig.
The authors advise against the use classifocation a bone mill to morcellise bone and reverse acetabular reaming for impaction. Some modifications of the original classification differentiate between type II and type III defects at 3 cm of superior migration. A segmental defect type I is defined as complete loss of bone in the hemisphere of the acetabulum, peripherally or centrally.