Bibliography for Acetabular Reinforcement Rings and Cages

Schatzker J, Wong M. Acetabular revision. The role of rings and cages. Clin Orthop. 1999;369:187-97.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10611874&dopt=Abstract

This study reports on the successful long-term use of the acetabular roof ring and the antiprotrusio cage in acetabular reconstruction in which the hip center and acetabular biomechanics are normalized and bone stock is restored through the use of morselized allograft. The advantages of the acetabular roof ring and antiprotrusio cage are significant:

  • They provide a large contact area between the implant and host bone without intervening cement.
  • They do not rely on bone ingrowth for stability.
  • They provide a large contact area between the implant and host bone thereby decreasing the chances of implant migration.
  • By normalizing the acetabular biomechanics they bring the resultant forces across the hip joint under the acetabular roof thereby reducing the chances for failure and help to restore leg length without having to resort to femoral modular components with excessively long necks.
  • They provide a method of successful bone augmentation by protecting the bone grafts during revascularization, incorporation, and remodeling.

Berry D, Lewallen D, Hanssen A, Cabanela M. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81:1692-1702.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10608380&dopt=Abstract

  • The purpose of this study was to describe the population of patients who are at risk for pelvic discontinuity, to identify the characteristic radiographic features associated with it, and to report the results of revision total hip arthroplasty.
  • For most hips with type-IVb and type-IVc bone loss, the authors prefer to use particulate bone graft or a single structural bone graft protected with an antiprotrusion cage.

Haddad F, Shergill N, Muirhead-Allwood S. Acetabular reconstruction with morcellized allograft and ring support. A medium-term review. J Arthroplasty. 1999;14:788-95.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10537251&dopt=Abstract

  • Acetabular deficiency presents a great challenge in revision hip surgery. 
  • A mechanically stable environment is one of the prerequisites for successful graft incorporation.  The reconstruction cages help to contain the graft, protect it from overload, and prevent motion between the allograft and the acetabular component.
  • The cages can also be used to reinforce a deficient acetabular roof and allow an acetabular component to be inserted independent of the bone-graft or metal cage.

This study confirms excellent medium-term outcomes for the support rings and cages in the management of acetabular deficiency.

Vena V, Hsu J, Rosier R, O’Keefe R.  Pelvic reconstruction for severe periacetabular metastatic disease. Clin Orthop. 1999;362:171-80.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10335296&dopt=Abstract

  • This study shows the efficacy of acetabular reconstruction in patients with severe metastatic disease and pathologic fracture.
  • In all cases, the acetabular bone defect was reconstructed by placement of an acetabular roof ring, screws that bridged the bone defect, and filling of the defect with polymethylmethacrylate bone cement.
  • Surgical intervention improved mobility, resulted in decreased narcotic use, and returned 16 of 21 patients to an independent status.
  • Although associated with a high complication rate, acetabular reconstruction for metastatic disease can lead to marked improvement in pain control, function, independence, and quality of life in carefully selected patients.

Korovessis P, Stamatakis M, Baikousis A, Katonis P, Petsinis G. Mueller Roof Reinforcement Rings. Medium term results. Clin Orthop. 1999;362:125-37.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10335291&dopt=Abstract

  • Sufficient primary ring fixation associated with sufficient segmental and morselized bone coverage and position of the socket close to its anatomic position led to good clinical and radiographic results.
  • In this small series, this surgical technique was successful and effective and followed by good medium-term clinical and radiographic results in primary and revision implantation in segmental, cavitary, or complex acetabular deficiencies and in osteoporotic or deficient acetabular bone.

Gill T, Siebenrock K, Oberholzer R, Ganz R. Acetabular reconstruction in developmental dysplasia of the hip. Results of the acetabular reinforcement ring with hook. J Arthroplasty. 1999;14:131-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10065716&dopt=Abstract

  • This study examined the clinical results and technical challenges associated with acetabular reconstruction in developmental dysplasia of the hip using the acetabular reinforcement ring with hook.
  • 33 consecutive acetabular reconstructions performed by a single surgeon were reviewed at an average follow-up of 6.7 years.
  • In reconstructing deficient acetabula, the authors recommend restoration of the anatomic hip center with the use of an ARRH and cemented polyethylene cup.
  • Use of the ARRH is associated with a low rate of acetabular osteolysis at 5- to 9-year follow-up.

Bohm P, Banzhaf S. Acetabular revision with allograft bone. 103 revisions with 3 reconstruction alternatives, followed for 0.3-13 years. Acta Orthop Scand. 1999;70:240-49.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10429598&dopt=Abstract

  • Good durability of allograft bone in reconstructions of bone deficiencies in acetabular revision surgery can be expected when the implant can bridge the temporary period of mechanical weakness of the allograft.
  • In severe acetabular deficiencies, reinforcement devices with sufficiently stable fixation in the host bone are usually preferred.

Gill TJ, Sledge JB, Muller ME. The Burch-Schneider anti-protrusio cage in revision total hip arthroplasty. Indications, principles and long-term results. J Bone Joint Surg Br. 1998;80:946-53.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9853483&dopt=Abstract

  • The Burch-Schneider APC is recommended for cases of major acetabular bone loss, particularly medial defects, large cavitary defects and combined deficiencies.
  • Secondary indications include osteoporosis and metastatic disease in which the strength of the host bone for a standard reconstruction is questioned.
  • By following the principles outlined in this article, long-term clinical success with restoration of bone stock can be expected.

Gill TJ, Sledge JB, Muller ME. Total hip arthroplasty with use of an acetabular reinforcement ring in patients who have congenital dysplasia of the hip. Results at five to fifteen years. J Bone Joint Surg Am. 1998;80:969-78.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9698001&dopt=Abstra

  • The authors recommend restoration of the anatomical hip center with the use of an acetabular roof-reinforcement ring and a polyethylene cup inserted with cement for the reconstruction of a deficient acetabulum.
  • The acetabular reinforcement ring prevents resorption of bone graft and migration of the cup, which are major causes of failure of the cup in patients who have had a reconstruction of a deficient acetabulum.
  • Bone graft should be used medially and superiorly as needed to augment bone stock notably. Cement should not be used to fill acetabular defects as we believe that it contributes to aseptic loosening.
  • No hip that was treated with the recommended method was revised due to aseptic loosening of the acetabular component, and only 2 percent had radiolucency.

Stockl B, Beerkotte J, Krismer M, Fischer M, Bauer R. Results of the Mueller Acetabular Reinforcement Ring in revision arthroplasty. Arch Orthop Trauma Surg. 1997;116:55-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9006767&dopt=Abstract

  • To compensate for acetabular deficiency, the Mueller acetabular reinforcement ring has proven very useful, especially in total hip revision, if the bone of the acetabulum is of poor quality or deficient.
  • The authors concluded that the Mueller ring shows good mid-term results (5-9 years).

Symeonides P, Petsatodes G, Pournaras J, Kapetanos G, Christodoulou A, Papadopoulos P. Replacement of deficient acetabulum using Burch-Schneider cages. 22 patients followed for 2-10 years.  Acta Orthop Scand Suppl. 1997;68:30-32.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9385261&dopt=Abstract

  • 22 patients (24 hips; 21 revision and 3 primary replacements: mean age 58 years) with substantial bone loss underwent acetabular reinforcement with Burch-Schneider cages.
  • After a mean follow-up of 8 (2-10) years, good stability was achieved in all patients and no mechanical failure was observed.
  • Satisfactory results were observed in all but one of the cases, indicating that effective support of the acetabulum can be achieved using Burch-Schneider cages.

Possai KW, Dorr LD, McPherson EJ. Metal ring supports for deficient acetabular bone in total hip replacement. Instr Course Lect, 1996;45:161-9.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8727735&dopt=Abstract

  • This article reports the early findings, indications, and recommendations for the use of acetabular reinforcement rings to reconstruct major acetabular deficiencies.

Peters CL, Curtain M, Samuelson KM. Acetabular revision with the Burch-Schneider antiprotrusio cage and cancellous allograft bone. J Arthroplasty. 1995;10:307-12.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7673909&dopt=Abstract

  • A retrospective review of 25 patients who underwent 28 acetabular revisions with the Burch-Schneider antiprotrusio cage and cancellous allograft bone was performed.
  • For failed acetabular components associated with moderate to massive bone loss, the antiprotrusio cage reliably reconstituted the hip joint center and acetabular bone stock.

Berry DJ. Acetabular anti-protrusio rings and cages in revision total hip arthroplasty. Sem Arthroplasty. 1995;6:68-75.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10155691&dopt=Abstract

  • This article discusses the rationale for selected use of acetabular reinforcement devices, the reported results of using acetabular reinforcement rings and cages in revision total hip arthroplasty, and the circumstances in which these devices may be considered for acetabular reconstruction.

Zehntner M, Ganz R. Midterm results (5.5-10 years) of acetabular allograft reconstruction with the acetabular reinforcement ring during total hip revision. J Arthroplasty. 1994;9:469-79.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7807103&dopt=Abstract

Haentjens P, DeBoeck H, Handelberg F, Casteleyn P, Opdecam P. Cemented acetabular reconstruction with the Mueller support ring. A minimum five-year clinical and roentgenographic follow-up study. Clin Orthop. 1993;290:225-35.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8472453&dopt=Abstract

Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;5:711-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1527119&dopt=Abstract

Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula.  J Bone Joint Surg Br. 1992;74:716-20.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1527120&dopt=Abstract