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32 results on '"Randau, Thomas Martin"'

21. Acetabular defects in revision hip arthroplasty: a therapy-oriented classification

Author

Wirtz, Dieter Christian, Jaenisch, Max, Osterhaus, Thiemo Antonius, Gathen, Martin, Wimmer, Matthias, Randau, Thomas Martin, Schildberg, Frank Alexander, and Rössler, Philip Peter

Subjects
Reoperation, Hip, Revision, Arthroplasty, Replacement, Hip, Acetabulum, General Medicine, Paprosky, Hip Arthroplasty, Classification, Arthroplasty, Postoperative Complications, Practice Guidelines as Topic, Humans, Orthopedics and Sports Medicine, Surgery, Hip Prosthesis, Bone Diseases
Abstract

Introduction The treatment of severe acetabular bone loss remains a difficult challenge. No classification system is available that combines intuitive use, structured design and offers a therapeutic recommendation according to the current literature and modern state of the art treatment options. The goal of this study is to introduce an intuitive, reproducible and reliable guideline for the evaluation and treatment of acetabular defects. Methods The proposed Acetabular Defect Classification (ADC) is based on the integrity of the acetabular rim and supporting structures. It consists of 4 main types of defects ascending in severity and subdivisions narrowing down-defect location. Type 1 presents an intact acetabular rim, type 2 includes a noncontained defect of the acetabular rim ≤ 10 mm, in type 3 the rim defect exceeds 10 mm and type 4 includes different kinds of pelvic discontinuity. A collective of 207 preoperative radiographs were graded according to ADC and correlated with intraoperative findings. Additionally, a randomized sample of 80 patients was graded according to ADC by 5 observers to account for inter- and intra-rater reliability. Results We evaluated the agreement of preoperative, radiographic grading and intraoperative findings presenting with a k value of 0.74. Interobserver agreement presented with a k value of 0.62 and intraobserver at a k value of 0.78. Conclusion The ADC offers an intuitive, reliable and reproducible classification system. It guides the surgeon pre- and intraoperatively through a complex field of practice.

Published
2020

32. [Use of custom-made acetabular components (CMAC) as part of a two-stage procedure in patients with severe periacetabular bone loss].

Author

Fröschen FS, Randau TM, Walter SG, Dally F, Wirtz DC, and Gravius S

Subjects
Acetabulum diagnostic imaging, Acetabulum surgery, Humans, Prosthesis Failure, Reoperation methods, Retrospective Studies, Treatment Outcome, Arthroplasty, Replacement, Hip methods, Hip Prosthesis
Abstract

Objective: Implantation of custom-made acetabular components (CMAC) with load transmission onto the remaining bone stock and reconstruction of the "center of rotation" (COR) in cases of severe periacetabular bone defects., Indications: Severe periacetabular bone loss (Paprosky type IIIA/B) with or without pelvic discontinuity after septic or aseptic loosening with inadequate load capacity of the dorsal pillar and/or large supraacetabular defects., Contraindications: Acute or local infections, lack of compliance, taking into account the risks and complications: missing or limited expected postoperative functional gain, multimorbid patients with potential inoperability during the first and/or second intervention., Surgical Technique: Lateral transgluteal or posterolateral approach while protecting neurovascular and muscular structures. Preparation of the implant site based on preoperative planning with augmentation of bone defects as far as possible. Primarily stable anchoring with 2 angle-stable pole screws in the ilium, an optional pole screw in the pubic bone for determination of COR, and stabilization screws in the iliac wing (optionally angle-stable). Use of dual mobility cup according to the soft tissue tension and intraoperative stability., Postoperative Management: For the first 6 weeks postoperative partial weight-bearing (20 kg), followed by a gradual increase of the load (10 kg per week)., Results: Between 2008 and 2018, 47 patients with a Paprosky type III defect underwent implantation of a monoflanged CMAC. Main complication was a periprosthetic joint infection with subsequent need for implant removal in 9 of 10 cases. Harris Hip Score improved from 21.1 to 61.5 points. X‑ray imaging displayed an angle of inclination of 42.3 ± 5.3°, an anteversion of 16.8 ± 6.2°, a ∆ H of 0.5 ± 0.2 mm and a ∆ V of 17.7 ± 1.1 mm according to Roessler et al., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Published
2022
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