Authors: Tomas Amenabar Wael A Rahman Bandar M Hetaimish Paul R Kuzyk Oleg A Safir Allan E Gross
Publish Date: 2015/02/25
Volume: 474, Issue: 2, Pages: 408-414
Abstract
Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity The cupcage CC construct where an ilioischial cage is cemented within a biologically fixed porous metal cup has emerged as an excellent option to treat such challengesWe sought to determine 1 midterm KaplanMeier survival 2 clinical outcomes based on Merle d’AubignéPostel scores 3 radiological outcomes based primarily on construct migration and 4 the complication rate for a series of 67 CC procedures performed at our institutionAll hip revision procedures between January 2003 and March 2012 where a CC was used with the exception of tumor cases or acute fracture four total cases that had a minimum 2year followup and that had been seen within the last 2 years were included in this retrospective review Acetabular bone loss and presence of pelvic discontinuity were assessed according to the Gross classification Sixtyseven CC procedures with an average followup of 74 months range 24–135 months SD 343 months were identified 26 of 67 39 were Gross Type IV and 41 of 67 61 were Gross Type V pelvic discontinuity Postoperative clinical and radiological evaluation was done annually Merle d’AubignéPostel scores were recorded and all radiographs were compared with the 6week postoperative radiographs to evaluate for radiographic loosening or migration Failure was defined as revision surgery for any cause including infectionThe 5year KaplanMeier survival rate with revision for any cause representing failure was 93 95 confidence interval CI 831–974 and the 10year survival rate was 85 95 CI 672–938 The Merle d’AubignéPostel score improved significantly from a mean of 6 preoperatively to 13 postoperatively p 0001 Four CC had nonprogressive radiological migration of the ischial flange and they remain stableWe believe that the CC construct is a suitable choice to treat chronic pelvic discontinuity it also remains a reliable option for the treatment of severe acetabular bone defects if stable fixation cannot be obtained through the use of a trabecular metal cup with or without augments
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