J Korean Hip Soc JKHS The Journal of the Korean Hip Society 1226-9409 The Korean Hip Society 10.5371/jkhs.2011.23.3.213 Original Article Revision Total Hip Arthroplasty Using Acetabular Reinforcement Ring - Midterm Follow-up Result - Kwak Sang Joon MD Chun Young Soo MD Rhyu Kee Hyung MD Huh Dong Bum MD Yoo Myung Chul MD Cho Yoon Je MD Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea. Address reprint request to: Yoon Je Cho, MD. Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea. TEL: +82-2-958-8346, FAX: +82-2-964-3865, yjcho@khmc.or.kr 09 2011 30 09 2011 23 3 213 220 15 01 2011 13 07 2011 13 07 2011 Copyright © 2011 by Korean Hip Society 2011 Purpose

To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring.

 Materials and Methods

Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years.

 Results

The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases.

 Conclusion

Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.

 Acetabulum Acetabular bone defect Reinforcement ring Revision total hip arthroplasty Haentjens P Handelberg F Casteleyn PP Opdecam P The Müller acetabular support ring. A preliminary review of indications and clinical results Int Orthop 1986 10 223 230 Gill TJ Sledge JB Müller ME The Bürch-Schneider anti-protrusio cage in revision total hip arthroplasty: indications, principles and long-term results J Bone Joint Surg Br 1998 80 946 953 Berry DJ Müller ME Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency J Bone Joint Surg Br 1992 74 711 715 Schlegel UJ Bitsch RG Pritsch M Clauss M Mau H Breusch SJ Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2-17 years Acta Orthop 2006 77 234 241 Gill TJ Siebenrock K Oberholzer R Ganz R Acetabular reconstruction in developmental dysplasia of the hip: results of the acetabular reinforcement ring with hook J Arthroplasty 1999 14 131 137 Gerber A Pisan M Zurakowski D Isler B Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty J Bone Joint Surg Am 2003 85-A 2358 2364 Schatzker J Wong MK Acetabular revision. The role of rings and cages Clin Orthop Relat Res 1999 369 187 197 Winter E Piert M Volkmann R Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty J Bone Joint Surg Am 2001 83-A 862 867 Schlegel UJ Bitsch RG Pritsch M Clauss M Mau H Breusch SJ Mueller reinforcement rings in acetabular revision: outcome in 164 hips followed for 2-17 years Acta Orthop 2006 77 234 241 Paprosky WG Perona PG Lawrence JM Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation J Arthroplasty 1994 9 33 44 Winter E Piert M Volkmann R Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty J Bone Joint Surg Am 2001 83-A 862 867 Zehntner MK Ganz R Midterm results (5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision J Arthroplasty 1994 9 469 479 Peters CL Curtain M Samuelson KM Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone J Arthroplasty 1995 10 307 312 Bierbaum BE Turner RH Scheller AD Jr Acetabular revision arthroplasty Revision total hip arthroplasty 1982 New York Grune & Stratton 42 79 Korovessis P Stamatakis M Baikousis A Katonis P Petsinis G Mueller roof reinforcement rings. Medium-term results Clin Orthop Relat Res 1999 362 125 137 Oh I Harris WH Design concepts, indications, and surgical technique for use of the protrusio shell Clin Orthop Relat Res 1982 162 175 184 Eggli S Müller C Ganz R Revision surgery in pelvic discontinuity: an analysis of seven patients Clin Orthop Relat Res 2002 398 136 145 Paprosky WG Magnus RE Principles of bone grafting in revision total hip arthroplasty. Acetabular technique Clin Orthop Relat Res 1994 298 147 155 Gross AE Allan DG Catre M Garbuz DS Stockley I Bone grafts in hip replacement surgery. The pelvic side Orthop Clin North Am 1993 24 679 695 Gross AE Duncan CP Garbuz D Mohamed EM Revision arthroplasty of the acetabulum in association with loss of bone stock Instr Course Lect 1999 48 57 66 Korovessis P Stamatakis M Baikousis A Katonis P Petsinis G Mueller roof reinforcement rings. Medium-term results Clin Orthop Relat Res 1999 362 125 137 Haentjens P de Boeck H Handelberg F Casteleyn PP Opdecam P Cemented acetabular reconstruction with the Muller support ring. A minimum five-year clinical and roentgenographic follow-up study Clin Orthop Relat Res 1993 290 225 235 Siebenrock KA Trochsler M Sadri H Ganz R Hooked roof cup in revision of difficult loose hip prosthesis cups. Results after a minimum of 10 years Orthopade 2001 30 273 279

51-years-old male. (A) The extensive osteolysis on acetabulum and proximal femur was found at 9 years after primary total hip arthroplasty. (B) The structural allograft was placed to support superior segmental defect of acetabulum and Burch-Schneider antiprutrusio cage was used for the acetabular revision. (C) Incorporation between structural allograft and host acetabular bone was found at 5 years after revision surgery.

61-years-old female. She had total hip arthroplasty at 9 years ago. (A) Revision arthroplasty have done using Müller ring with mixed bone graft. (B) Failure of revision total hip arthroplasty with Müller ring was found at 5 years from the surgery. The ring was placed with high abduction angle at revision surgery. (C) Bone quality of the acetabulum of the patient was poor due to radiation therapy on the pelvic area for the cervical cancer.

54-years-old male. He had total hip arthroplasty at 6 years ago. (A) There was extensive osteolysis on the acetabulum. (B) The Ganz ring was well placed and (C) successful incorporation of grafted bone was found at 6 years after revision surgery.

(A) 60-years-old female. He had total hip arthroplasty at 15 years ago. (B) The acetabular revision was done with Müller ring and mixed bone graft. (C) Stable cage fixation with successful bony incorporation was seen on the radiograph at 6 years after the surgery.

The Prostheses in Use

The Acetabular Bone Defect

Changes in Vertical and Horizontal Center of Rotation. (mm)

Lateralization of Hip Center According to the Prostheses. (mm)