Titanium cage reconstruction of acetabular defects in revision hip arthroplasty results in favourable outcomes: up to 17 years follow-up

Abstract

Introduction: Titanium cages are valuable implant solutions in management of severe acetabular defects during total hip revisions. We aimed to report clinical and radiological results of our cases in which we used titanium cages for reconstruction of acetabular defects. Methods: Patients underwent titanium cage reconstruction and bone grafting for their acetabular defects with minimum 2 year-follow-up are included to the study. Analysis of patient records, modified Hospital for Special Surgery hip score and radiological examinations on plain X-rays were evaluated. Acetabular defects are classified according to Paprosky's classification. Kaplan Meier survival analysis is performed. Results: Fifty-six hips of 54 patients (2 bilateral) aged between 29-79 (mean 57 years ) are followed up for 7.06 years +/- 3.72 (2-17 years). Five patients required revision surgeries at a mean of 2.6 +/- 2.2 years. Kaplan Meier's analysis revealed a survival rate of 91,5 % and mean revision free duration was 15,66 +/- 0,56 years. HSS scores of the patients before revision surgery yielded a mean score of 27,9 +/- 4,9 (14-38). HSS scores at final follow up showed a significant improvement at a mean score of 45,9 +/- 7 (28-56) differences were statistically significant, p<0,001) Discussion: Titanium cages are successful for restoring bone stock in severe acetabular defects. It is critical to pay attention on meticulous bone grafting of the presented defects and obtain good hip mechanics during cage insertion. Mechanical reasons are the leading cause of failure in long term but restoration of the bone stock and improvement in defect severity were regularly observed even in failed cages.