The survival of support rings in complex acetabular revision surgery

Author:

Carroll F. A.1,Hoad-Reddick D. A.2,Kerry R. M.3,Stockley I.3

Affiliation:

1. Wirrall University Teaching Hospital, NHS Foundation Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK.

2. Centre for Hip Surgery, Wrightington Hospital, Appley, Bridge, Lancashire WN6 9EP, UK.

3. The Lower Limb Arthroplasty Unit, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.

Abstract

Between 1980 and 2000, 63 support rings were used in the management of acetabular deficiency in a series of 60 patients, with a mean follow-up of 8.75 years (2 months to 23.8 years). There was a minimum five-year follow-up for successful reconstructions. The indication for revision surgery was aseptic loosening in 30 cases and infection in 33. All cases were Paprosky III defects; IIIA in 33 patients (52.4%) and IIIB in 30 (47.6%), including four with pelvic dissociation. A total of 26 patients (43.3%) have died since surgery, and 34 (56.7%) remain under clinical review. With acetabular revision for infection or aseptic loosening as the definition of failure, we report success in 53 (84%) of the reconstructions. A total of 12 failures (19%) required further surgery, four (6.3%) for aseptic loosening of the acetabular construct, six (9.5%) for recurrent infection and two (3.2%) for recurrent dislocation requiring captive components. Complications, seen in 11 patients (18.3%), included six femoral or sciatic neuropraxias which all resolved, one grade III heterotopic ossification, one on-table acetabular revision for instability, and three early post-operative dislocations managed by manipulation under anaesthesia, with no further instability. We recommend support rings and morcellised bone graft for significant acetabular bone deficiency that cannot be reconstructed using mesh.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Orthopedics and Sports Medicine,Surgery

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