Early clinical and radiological outcomes of the new porous titanium shell in combination with locking screw in revision total hip arthroplasty

Shahril R Shaarani; Monketh Jaibaji; Khaled M Yaghmour; Georges Vles; Fares S Haddad; Sujith Konan

doi:10.1186/s42836-023-00177-4

Early clinical and radiological outcomes of the new porous titanium shell in combination with locking screw in revision total hip arthroplasty

Arthroplasty. 2023 May 8;5(1):24. doi: 10.1186/s42836-023-00177-4.

Authors

Shahril R Shaarani¹, Monketh Jaibaji², Khaled M Yaghmour², Georges Vles³, Fares S Haddad³, Sujith Konan³

Affiliations

¹ Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK. delphaex@gmail.com.
² University College London, London, NW1 2BU, UK.
³ Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK.

Abstract

Introduction: Extensive acetabular bone loss and poor bone quality are two key challenges often encountered in revision total hip arthroplasty. A new 3D-printed porous acetabular shell has been made available with the option to insert multiple variable-angle locking screws. We sought to evaluate the early clinical and radiological outcomes of this construct.

Methods: A retrospective review of patients operated by two surgeons was performed in a single institution. Fifty-nine revision hip arthroplasties were performed in 55 patients (34 female; mean age 68.8 ± 12.3 years) for Paprosky defects I (n = 21), IIA/B (n = 22), IIC (n = 9), III (n = 7) between February 2018 and January 2022 using the novel porous titanium acetabular shell and multiple variable angle locking screws. Postoperative clinical and radiographic outcomes were locally maintained. Patient-reported outcome measures collected included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score, and the 12-item Short Form Survey.

Results: After a mean follow-up of 25.7 ± 13.9 months, two cases of shell migration were noted. One patient had a failed constrained mechanism and received revision to a cemented dual mobility liner. No other acetabular shells showed any evidence of radiographic loosening at the final follow-up. Preoperatively, 21 defects were classified as Paprosky grade I, 19 grade IIA, 3 grade IIB, 9 IIC, 4 grade IIIA, and 3 IIIB. The mean postoperative WOMAC function score was 84 (SD 17), WOMAC (stiffness) 83 (SD 15), WOMAC (pain) 85 (SD 15), and WOMAC (global) 85 (SD 17). The mean postoperative OHS was 83 (SD 15), and mean SF-12 physical score was 44 (SD 11).

Conclusion: The additional augmentation of porous metal acetabular shells with multiple variable-angle locking screws provides reliable initial fixation with good clinical and radiological outcomes in the short term. Further studies are needed to establish the medium- and long-term outcomes.

Level of evidence: IV.

Keywords: Bone loss; Paprosky; Revision acetabular shell; Revision arthroplasty.