Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets

English version

Autoři: Ronja A. Schierjott ^aff001; Georg Hettich ^aff001; Heiko Graichen ^aff003; Volkmar Jansson ^aff002; Maximilian Rudert ^aff004; Francesco Traina ^aff005; Patrick Weber ^aff002; Thomas M. Grupp ^aff001
Působiště autorů: Research & Development Department, B.Braun Aesculap AG, Tuttlingen, Germany ^aff001; Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany ^aff002; Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany ^aff003; Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Würzburg, Germany ^aff004; Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy ^aff005; Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università Degli Studi Di Messina, Messina, Italy ^aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222511

Souhrn

Objectives

Acetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to analyze 50 bone defects and to present the results and correlations between the defined parameters.

Methods

The analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed.

Results

Bone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and [25, 75]—percentile values of 72.8 [50.6, 95.0] %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 [1.1, 1.4] with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° [21.5°, 40.4°], which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 [14.8, 32.7] mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67).

Conclusion

Within this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.

Klíčová slova:

Medical implants – Pelvis – Hip – Computed axial tomography – Cements – Biomaterial implants – Bone development – Surgeons

Zdroje

1. 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. doi: 10.1016/0883-5403(94)90135-x 8163974

2. D'Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boetticher WG, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clinical Orthopaedics and Related Research. 1989: 126–137.

3. Saleh KJ, Holtzman J, Gafni A, Saleh L, Jaroszynski G, Wong P, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J. Orthop. Res. 2001; 19: 50–56. doi: 10.1016/S0736-0266(00)00021-8 11332620

4. Johanson NA, Driftmier KR, Cerynik DL, Stehman CC. Grading acetabular defects. The need for a universal and valid system. J Arthroplasty. 2010; 25: 425–431. doi: 10.1016/j.arth.2009.02.021 19375888

5. Engh CA, Sychterz CJ, Young AM, Pollock DC, Toomey SD, Engh CA. Interobserver and intraobserver variability in radiographic assessment of osteolysis. J Arthroplasty. 2002; 17: 752–759. doi: 10.1054/arth.2002.33554 12216030

6. Safir O, Lin C, Kosashvili Y, Mayne IP, Gross AE, Backstein D. Limitations of conventional radiographs in the assessment of acetabular defects following total hip arthroplasty. Can J Surg. 2012; 55: 401–407. doi: 10.1503/cjs.000511 22992397

7. Horas K, Arnholdt J, Steinert AF, Hoberg M, Rudert M, Holzapfel BM. Acetabular defect classification in times of 3D imaging and patient-specific treatment protocols. Der Orthopäde. 2017; 46: 168–178. doi: 10.1007/s00132-016-3378-y 28078371

8. Gelaude F, Clijmans T, Delport H. Quantitative computerized assessment of the degree of acetabular bone deficiency: Total radial Acetabular Bone Loss (TrABL). Adv Orthop. 2011: 1–12. doi: 10.4061/2011/494382 22013539

9. Gelaude F, Demol J, Clijmans T, Delport H. CT-based quantification of bone loss for refined classification of acetabular deficiencies: comparison of 30 Paprosky type IIIA-B cases. Orthopaedic Proceedings. 2013; 95-B: 26.

10. Hettich G, Schierjott RA, Ramm H, Graichen H, Jansson V, Rudert M, et al. Method for quantitative assessment of acetabular bone defects. J. Orthop. Res. 2018: 1–9. doi: 10.1002/jor.24165 30345568

11. Henle P, Tannast M, Siebenrock KA. Imaging in developmental dysplasia of the hip. Der Orthopäde. 2008; 37: 525–531. doi: 10.1007/s00132-008-1235-3 18496670

12. Calkins KG. Applied Statistics—Lesson 5. Correlation coefficients; 2005. Available: https://www.andrews.edu/~calkins/math/edrm611/edrm05.htm. Accessed 7 June 2019.

13. Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, David SS. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002; 84: 609–614. doi: 10.2106/00004623-200204000-00016 11940623

14. Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg Am. 2005; 87: 592–597. doi: 10.2106/JBJS.D.02116 15741627

15. Garcia Cimbrelo E, Tapia M, Hervas CM. Assessment of bone defects around the acetabular cup with use of multislice computed tomography in total hip replacement. Orthopaedic Proceedings. 2006; 88-B: 49–50.

16. Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice Computed Tomography for Evaluating Acetabular Defects in Revision THA. Clinical Orthopaedics and Related Research. 2007: 138–143.

17. García-Rey E, Garcia-Cimbrelo E, Martin-Hervas C. Assessment of bone defects around the acetabular cup with use of multislice computed tomography in total hip replacement. Orthopaedic Proceedings. 2006; 88-B: 64–65.

18. Tapia M, Garcia-Cimbrelo E, Martín-Hervás C. Assessment of acetabular defects through the use of multislice-CT in total hip prostheses. Orthopaedic Proceedings. 2005; 87-B: 83.

19. Egawa H, Ho H, Huynh C, Hopper RH, Engh CA, Engh CA. A three-dimensional method for evaluating changes in acetabular osteolytic lesions in response to treatment. Clinical Orthopaedics and Related Research. 2010; 468: 480–490. doi: 10.1007/s11999-009-1050-0 19701674

20. Howie DW, Neale SD, Martin W, Costi K, Kane T, Stamenkov R, et al. Progression of periacetabular osteolytic lesions. J Bone Joint Surg Am. 2012; 94: e1171–6. doi: 10.2106/JBJS.K.00877 22992823

21. Stamenkov RB, Howie DW, Neale SD, McGee MA, Taylor DJ, Findlay DM. Distribution of periacetabular osteolytic lesions varies according to component design. J Arthroplasty. 2010; 25: 913–919. doi: 10.1016/j.arth.2009.08.003 19775854

22. Wright G, Paprosky WG. Acetabular Reconstruction: Classification of Bone Defects and Treatment Options; 2016. Available: https://musculoskeletalkey.com/acetabular-reconstruction-classification-of-bone-defects-and-treatment-options/. Accessed 12 December 2018.

23. Wassilew GI, Janz V, Perka C, Mueller M. Treatment of acetabular defects with the trabecular metal revision system. Der Orthopäde. 2017; 46: 148–157. doi: 10.1007/s00132-016-3381-3 28083681

24. Villatte G, Erivan R, Salles G, Pereira B, Galvin M, Descamps S, et al. Acetabular bone defects in THA revision: Reconstruction using morsellised virus-inactivated bone allograft and reinforcement ring. Seven-year outcomes in 95 patients. Orthop Traumatol Surg Res. 2017; 103: 543–548. doi: 10.1016/j.otsr.2017.03.008 28366746

25. Sandgren B, Crafoord J, Garellick G, Carlsson L, Weidenhielm L, Olivecrona H. Computed tomography vs. digital radiography assessment for detection of osteolysis in asymptomatic patients with uncemented cups. A proposal for a new classification system based on computer tomography. J Arthroplasty. 2013; 28: 1608–1613. doi: 10.1016/j.arth.2013.01.029 23618751

26. Amirouche F, Solitro GF, Walia A, Gonzalez M, Bobko A. Segmental acetabular rim defects, bone loss, oversizing, and press fit cup in total hip arthroplasty evaluated with a probabilistic finite element analysis. Int Orthop. 2017; 41: 1527–1533. doi: 10.1007/s00264-016-3369-y 28012048

27. Paprosky WG, Cross MB. CORR Insights®: Validity and reliability of the Paprosky acetabular defect classification. Clinical Orthopaedics and Related Research. 2013; 471: 2266. doi: 10.1007/s11999-013-2938-2 23613087