This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gerber, A.
Right arrow Articles by Isler, B.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Gerber, A.
Right arrow Articles by Isler, B.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery (American) 85:2358-2364 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Ganz Reinforcement Ring for Reconstruction of Acetabular Defects in Revision Total Hip Arthroplasty

Ariane Gerber, MD1, Markus Pisan, MD2, David Zurakowski, PhD3 and Balz Isler, MD2

1 Clinic for Trauma and Reconstructive Surgery, Humboldt University, Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. E-mail address: ariane.gerber{at}charite.de
2 Department of Orthopaedic Surgery, Kantonspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
3 Departments of Orthopaedic Surgery and Biostatistics, Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115

Investigation performed at the Department of Orthopaedic Surgery, Kantonspital Winterthur, Winterthur, Switzerland

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: In revision total hip arthroplasty, bone loss due to loosening and migration of the acetabular component makes fixation of a new implant difficult. The purpose of this study was to evaluate the clinical and radiographic outcomes of the use of the Ganz reinforcement ring with nonstructural allograft in the reconstruction of acetabular defects.

Methods: Sixty-one acetabular revisions performed with use of the Ganz reinforcement ring and nonstructural allograft, between 1989 and 1992, in fifty-seven patients with aseptic loosening met our selection criteria. Eleven hips in eleven patients were lost to follow-up, leaving fifty hips available for evaluation five years or more following surgery. According to the American Academy of Orthopaedic Surgeons classification, twenty-four acetabular defects were Type II, twenty-four were Type III, and two were Type IV. Clinical and radiographic evaluations were carried out at a mean of six and nine years after surgery. Twelve more patients were lost to follow-up before the most recent evaluation.

Results: The mean Merle d'Aubigné composite score increased significantly compared with the preoperative score (p < 0.001). There were seven failures: six cases of aseptic loosening and one case of septic arthritis. Graft incorporation and bone remodeling occurred in all hips but three in which the ring fixation had been inadequate at the time of surgery. The Kaplan-Meier survivorship rate, with use of revision or loosening of the component as the criterion of failure, was 81% at ten years. Inadequate fixation of the implant at the time of surgery was the only multivariate predictor of failure (p = 0.003).

Conclusions: Patients treated with acetabular revision with a Ganz reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results, provided that the ring had been fixed adequately at the time of surgery. This procedure may not be the preferred approach for reconstructing segmental defects of the medial wall or pelvic discontinuity.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Bone Joint Surg BrHome page
N. P. Badhe and P. W. Howard
A stemmed acetabular component in the management of severe acetabular deficiency
J Bone Joint Surg Br, December 1, 2005; 87-B(12): 1611 - 1616.
[Abstract] [Full Text] [PDF]