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Ischial screw fixation can prevent cup migration in 3D-printed custom acetabular components for complex hip reconstruction

Authors :
Suroosh Madanipour
Daniel Lemanu
Chethan Jayadev
Will Aston
James Donaldson
Jonathan Miles
Richard Carrington
Robert McCulloch
John Skinner
Source :
Arthroplasty, Vol 4, Iss 1, Pp 1-7 (2022)
Publication Year :
2022
Publisher :
BMC, 2022.

Abstract

Abstract Introduction Custom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration. Methods Electronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event. Results No ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X 2 = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X 2 = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X 2 = 1.2, P = 0.26). Conclusion The results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.

Details

Language :
English
ISSN :
25247948
Volume :
4
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Arthroplasty
Publication Type :
Academic Journal
Accession number :
edsdoj.1e37277160c34400b7cd8877e4cf8e72
Document Type :
article
Full Text :
https://doi.org/10.1186/s42836-022-00154-3