Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity

Article type: Research Article

Authors: Fröschen, Frank S.^a | Randau, Thomas M.^a | Gravius, Nadine^a | Wirtz, Dieter C.^a | Gravius, Sascha^b | Walter, Sebastian G.^{c; *}

Affiliations: [a] Department of Orthopaedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany | [b] Department of Orthopaedic Surgery and Traumatology, University Hospital Mannheim, Mannheim, Germany | [c] Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany

Correspondence: [*] Corresponding author: Sebastian G. Walter, Department of Orthopaedic Surgery and Traumatology, University Hospital Cologne, Cologne, Germany. Tel.: +49 228 287 15477; Fax: +49 228 287 15044; E-mail: Sebastianwalter01@gmail.com.

Abstract: BACKGROUND: Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. OBJECTIVE: The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. METHODS: Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. RESULTS: The average follow-up was 41.9 ± 34.8 months (range 1.5–120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. CONCLUSION: Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.

Keywords: Revision total hip arthroplasty, pelvic discontinuity, acetabular bone loss, custom-made implant, risk factor, treatment failure, periprosthetic joint infection, aseptic loosening

DOI: 10.3233/THC-202236

Journal: Technology and Health Care, vol. 30, no. 3, pp. 703-711, 2022