• Hip & pelvis
• /
• 제35권2호
• /
• pp.122-132
• /
• 2023

Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique. Materials and Methods: A multicenter case series was conducted for evaluation of patients who underwent revision THA using the dome technique for management of Paprosky 3B anterosuperior medial acetabular bone loss from 2013-2019 with a minimum clinical follow-up period of two years. Twelve cases in 12 patients were identified. Baseline demographics, intraoperative variables, surgical outcomes, and patient reported outcomes were acquired. Results: The implant survivorship was 91% with component failure requiring re-revision in only one patient at a mean follow-up period of 36.2 months (range, 24-72 months). Three patients (25.0%) experienced complications, including re-revision for component failure, inter-prosthetic dual-mobility dissociation, and periprosthetic joint infection. Of seven patients who completed the HOOS, JR (hip disability and osteoarthritis outcome score, joint replacement) survey, five patients showed improvement. Conclusion: Excellent outcomes can be achieved using the dome technique for management of massive anterosuperior medial acetabular defects in revision THA with survivorship of 91% at a mean follow-up period of three years. Conduct of future studies will be required in order to evaluate mid- to long-term outcomes for this technique.

• Hip & pelvis
• /
• 제35권4호
• /
• pp.277-280
• /
• 2023

Dislocation after a total hip arthroplasty occurs in approximately 1% of patients; however, the frequency is much higher after revision surgery. To prevent dislocation, use of a larger femoral head is recommended, and a dual mobility femoral head has been introduced. However, reducing the dual mobility femoral head to the acetabular component is difficult in cases involving contracture in the soft tissue around the joint. A 72-year-old male patient who developed a periprosthetic joint infection underwent two-stage revision surgery using MUTARS^®. Two months after the revision, the hip joint became dislocated and manual reduction was attempted; however, dislocation occurred again. During another revision using a dual mobility bearing, the soft tissue around the hip joint was too tight to reduce. The problem was overcome by first repositioning the dual mobility head into the acetabular socket, followed by assembly of the diaphyseal portion of the implant.

• Hip & pelvis
• /
• 제36권3호
• /
• pp.179-186
• /
• 2024

Intraoperative acetabular fractures (IAFs), a complication seldomly encountered in total hip arthroplasty, are typically a result of the impact of insertion of a cementless press-fit cup. Factors that contribute to the risk of these types of fractures include poor bone quality, highly sclerotic bone, and the use of a press-fit cup that is excessively large. The approach to management of these fractures is dependent on when they are identified. Immediate stabilization measures should be implemented for management of fractures detected during surgery. When fractures are detected postoperatively, the decision regarding conservative treatment is dependent on the stability of the implant and the specific fracture pattern. In the majority of cases, effective treatment of an acetabular fracture detected intraoperatively can be administered using a multi-hole revision cup along with anchoring screws in the various regions of the acetabulum. Selection of plate osteosynthesis of the posterior column is recommended when there is a large posterior wall fragment or pelvic discontinuity. In cases where anatomical dimensions allow, cup-cage reconstruction may offer a promising alternative to a combined hip procedure. The number of reports addressing the management of IAFs is limited. This review focuses on outlining the strategies that are currently available for management of this seldomly encountered complication.

• 대한의용생체공학회:의공학회지
• /
• 제25권6호
• /
• pp.455-464
• /
• 2004

현재 인공고관절 전치환 수술 과정의 높은 난이도 때문에 숙련된 의사의 경험에 상당히 의존하고 있는 실정이다. 비구컵과 대퇴 임플란트의 위치 선정은 수술의 성공 여부와 밀접한 관계가 있지만 아직까지는 의사의 눈대중에 의해 이루어지는 경우가 많다. 이러한 이유로 인하여 인공삽입물(비구컵, 대퇴시스템) 삽입의 정확성이 낮아서 재치환술을 해야 하는 경우가 자주 발생한다. 본 연구에서는 환자 골반골(pelvis)과 대퇴골(femur)의 3차원적인 고유 기하학적 정보를 이용하는 모사 시술을 통하여 비구컵과 대퇴 임플란트의 정확한 위치를 선정하는 방법을 결정하였다. 이를 위하여 우선 비구컵의 위치 변화에 따른 대퇴 전염각 및 대퇴 경간각의 변화 양상을 살펴보았고 또한 대퇴 임플란트의 삽입 위치에 따른 대퇴스템 경부 길이 및 대퇴스템각의 변화 양상을 조사하였다. 본 연구에서 다양한 모사 시술을 통한 기하학적 정보의 분석 결과 비구컵과 대퇴 임플란트의 정확한 위치 선정이 가능함을 확인하였다. 본 연구의 모사 시술 방법을 이용하여 의사가 인공고관절 수술을 선행한다면 수술의 정확도와 숙련도를 향상시킬 수 있을 것으로 기대된다.

• Hip & pelvis
• /
• 제36권2호
• /
• pp.155-160
• /
• 2024

We report two cases of postoperative total hip arthroplasty periprostehtic fracture of the acetabulum which treated by open reduction with internal fixation without acetabular cup revision. From these cases, we should consider open reduction with internal fixation as the first treatment option in cases where spot welding of the cup to the host bone is observed.

• Hip & pelvis
• /
• 제30권4호
• /
• pp.276-281
• /
• 2018

Pseudotumors are not uncommon complications after total hip arthroplasty (THA) and may occur due to differences in bearing surfaces of the head and the liner ranging from soft to hard articulation. The most common causes of pseudotumors are foreign-body reaction, hypersensitivity and wear debris. The spectrum of pseudotumor presentation following THA varies greatly-from completely asymptomatic to clear implant failure. We report a case of pseudo-tumor formation with acetabular cup aseptic loosening after revision ceramic-on-metal hip arthroplasty. The patient described herein underwent pseudotumor excision and re-revision complex arthroplasty using a trabecular metal shell and buttress with ceramic-on-polyethylene THA. Surgeons should be aware of the possibility of a pseudotumor when dealing with revisions to help prevent rapid progression of cup loosening and implant failure, and should intervene early to avoid complex arthroplasty procedures.

• Hip & pelvis
• /
• 제35권1호
• /
• pp.54-61
• /
• 2023

Purpose: The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods: A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results: Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion: Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.