Jumbo acetabular cups may offer advantages in revision arthroplasty
ORLANDO, Fla. — The use of jumbo acetabular cups is a reliable technique in revision arthroplasty, according to a speaker at the Current Concepts in Joint Replacement Winter Meeting.
“You can find a high rate of success at 10 years with a jumbo component,” Paul F. Lachiewicz, MD, said.
Jumbo acetabular components, which are those with a diameter greater than or equal to 62 mm in women and 66 mm in men, have multiple advantages, he said. Techniques for successful jumbo acetabular revisions involve proper sizing, reaming of the acetabulum, careful impaction to achieve a press fit, multiple screw fixation and the use of large heads and cancellous allografts for cavitary defects.
Contraindications for the use of a jumbo acetabular cup include pelvic dissociation, inability to get a rim fit or screw fixation and patients with less than 50% living host bone in the acetabulum, Lachiewicz said.
Paul F. Lachiewicz
Lachiewicz said good long-term data for revision arthroplasty with jumbo acetabular cups have been reported. He and colleagues recently reported 15-year survival data for 129 revisions, which predominantly used titanium fiber-metal mesh components. There was a 3% revision rate for deep infection and 3% revision rate for aseptic loosening. Overall, there were 13 reoperations for other reasons, which included wear, lysis, dislocation, femoral loosening and femoral fracture fixation. Ten-year survival was 97.3% and 15-year survival was 82.8%. Lachiewicz said late loosening was likely related to polyethylene wear and loss of fixation. Dislocation was the most common complication of jumbo acetabular revisions. He said there was a lower risk of dislocation if the head was sized greater than or equal to 32 mm.
“I want to caution you, at least with first-generation surfaces, that mechanical failure increases in the second decade. We hope to have better success with the newer surfaces. With the complication of dislocation, I recommend big heads for all acetabular revisions,” Lachiewicz said. – by Kristine Houck, MA, ELS
Lachiewicz PF. Paper #62. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 10-13, 2014; Orlando, Fla.
Disclosure: Lachiewicz has no relevant financial disclosures.