Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty

Hotaka Ishizu; Tomohiro Shimizu; Fumio Sasazawa; Daisuke Takahashi; Mohamad Alaa Terkawi; Kaname Takahashi; Yusuke Ohashi; Masahiro Kanayama; Norimasa Iwasaki

doi:10.1186/s12891-023-06240-0

Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty

BMC Musculoskelet Disord. 2023 Feb 20;24(1):134. doi: 10.1186/s12891-023-06240-0.

Authors

Hotaka Ishizu¹, Tomohiro Shimizu², Fumio Sasazawa³, Daisuke Takahashi¹, Mohamad Alaa Terkawi¹, Kaname Takahashi³, Yusuke Ohashi³, Masahiro Kanayama³, Norimasa Iwasaki¹

Affiliations

¹ Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan.
² Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan. simitom@wg8.so-net.ne.jp.
³ Department of Orthopaedic Surgery, Hakodate Central General Hospital, Hakodate, Hon-cho 33-2, 040-8585, Japan.

Abstract

Background: This study compared the re-revision rate and radiographic outcomes of revision total hip arthroplasty (THA) using a Kerboull-type acetabular reinforcement device (KT plate) with bulk structural allograft and metal mesh with impaction bone grafting (IBG).

Methods: Ninety-one hips of 81 patients underwent revision THA for American Academy of Orthopedic Surgeons (AAOS) classification type III defects from 2008 to 2018. Of these, seven hips of five patients and 15 hips of 13 patients were excluded due to insufficient follow-up information (< 24 months) and large bone defects with a vertical defect height ≥ 60 mm, respectively. The current study compared the survival and radiographic parameters of 45 hips of 41 patients using a KT plate (KT group) and 24 hips of 24 patients using a metal mesh with IBG (mesh group).

Results: Eleven hips (24.4%) in the KT group and 1 hip (4.2%) in the mesh group exhibited radiological failure. Moreover, 8 hips in the KT group (17.0%) required a re-revision THA, while none of the patients in the mesh group required a re-revision. The survival rate with radiographic failure as the endpoint in the mesh group was significantly higher than that in the KT group (100% vs 86.7% at 1-year and 95.8% vs 80.0% at 5-years, respectively; p = 0.032). On multivariable analysis evaluating factors associated with radiographic failure, there were no significant associations with any radiographic measurement. Of the 11 hips with radiographic failure, 1 (11.1%), 3 (12.5%), and 7 (58.3%) hips were of Kawanabe classification stages 2, 3, and 4, respectively.

Conclusions: The findings of this study suggest that revision THA using KT plates with bulk structure allografts could provide poorer clinical outcomes than revision THA using a metal mesh with IBG. Although revision THA using KT plates with bulk structural allografts could set the true hip center, there is no association between a high hip center and clinical outcomes. The relationship between the position of the KT plate and the host bone might be considered more carefully.

Keywords: Impaction bone grafting; Kerboull-type plate; Metal mesh; Revision total hip arthroplasty; Vertical defect height.

MeSH terms

Acetabulum / diagnostic imaging
Acetabulum / surgery
Arthroplasty, Replacement, Hip* / adverse effects
Bone Transplantation
Follow-Up Studies
Hip Prosthesis*
Humans
Metals
Prosthesis Failure
Reoperation
Retrospective Studies
Surgical Mesh
Treatment Outcome

Substances

Metals