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The Journal of Hip Surgery 2021; 05(01): 032-046
DOI: 10.1055/s-0041-1727177
Original Article

Trabecular Metal Augments for Treatment of Acetabular Defects: A Systematic Review

Michael-Alexander Malahias
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Fabio Mancino 
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Alex Gu
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Ivan De Martino
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Danilo Togninalli
2   Department of Orthopedics and Traumatology, Clinica ARS Medica, Ticino, Switzerland
,
Mathias P. Bostrom
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Peter K. Sculco
1   The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
› Author Affiliations Funding Dr. Sculco reports personal fees from EOS Imaging and LimaCorporate, and grants from LimaCorporate outside the submitted work. Dr. Bostrom reports grants and personal fees from Smith & Nephew, and grants from NIH/NIAMS (grant: R21 AR071534) and Ines Mandl Research Foundation outside the submitted work. In addition, Dr. Bostrom has a hip stem patent with Smith & Nephew with royalties paid. Dr. Martino reports that he is a paid consultant for LimaCorporate.
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Abstract

Severe acetabular bone defects during revision total hip arthroplasty are often treated with a hemispherical shell and highly porous modular metal augments. Several papers have been already published reporting on the clinical performance of trabecular metal (TM) augments combined with a hemispherical shell for the management of severe acetabular defects. However, no systematic review of the literature has been published to date. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications utilizing keywords pertinent to tantalum augments and TM (Zimmer Biomet, Warsaw, Indiana) augments, revision THA, clinical outcomes, and complications associated with these procedures. Fifteen articles were found to be suitable for inclusion in the present study, which included 769 revision cases where acetabular augments were used. The majority of acetabular bone defects were type 3 according to the Paprosky classification (type 2A in 58 cases, 7.2%; type 2B in 139 cases, 17.2%; type 2C in 72 cases, 8.9%; type 3A in 360 cases, 44.7%; and type 3B in 177 cases, 22.0%). The overall revision rate for the 769 acetabular revisions with augments was 5.7% (46 cases) at mean mid-term follow-up. The most common reasons for revision were dislocation (3.3%), periprosthetic joint infection (2.9%), and aseptic loosening (2.7%). TM augments combined with hemispherical shells were found to be effective in the treatment of moderate-to-severe acetabular bone defects with a 5% acetabular component revision rate at mean mid-term follow-up. The literature did not delineate whether pelvic discontinuity was associated with a higher risk of aseptic loosening after TM augment. Further studies are needed to clarify the impact of additional screw fixation on survival rates, and whether the type of augment (wedge augments, “flying buttress” augments, column augments), the configuration used, and the number of screws influence clinical and radiographic outcomes.

Keywords

trabecular metal augments - total hip arthroplasty - acetabular bone loss - revision arthroplasty - tantalum augments


Publication History

Received: 30 September 2019

Accepted: 10 December 2020

Article published online:
24 May 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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