The Burch-Schneider Reinforcement Ring : 200 cases over a 40-year period with a mean follow-up of 11 years.

Abstract

The Burch-Schneider Reinforcement Ring (BSRR) was developed to manage significant acetabular defects and prevent protrusion in complex primary and revision total hip arthroplasties. This study evaluates the long-term performance of the BSRR over four decades, focusing on survival, patient-reported outcomes, radiological evidence of loosening, complication rates, and factors associated with implant failure. We conducted a retrospective analysis of 200 hips treated with the BSRR at the Cantonal Hospital of Fribourg, Fribourg, Switzerland, from January 1974 to December 2018. Clinical and radiological data were reviewed, and patients were followed through clinical visits, questionnaires, and registry data. Outcomes were assessed using standardized scoring systems and radiological evaluations. Kaplan-Meier survival analysis and Cox proportional hazards modelling were used to identify factors associated with implant failure. The cumulative survival of the BSRR was 72% (95% CI 50 to 100) at 20 years with any clinical or radiological failure as the endpoint, and 97% (95% CI 95 to 100) at 20 years for revision of the BSRR specifically. Clinical outcomes showed moderate improvements at final-follow-up, with a mean Harris Hip Score of 53.4 (SD 25.3) and a Hip disability and Osteoarthritis Outcome Score of 72.8 (SD 18.6). Radiologically at final follow-up, the BSRR demonstrated good stability, with 1.5% of cases (n = 2) showing probable loosening and low rates of osteolysis (3% acetabular (n = 4) and 14% femoral (n = 18)). The primary predictor of implant failure was the Paprosky Grade IV acetabular defect, with a hazard ratio of 4.4 (95% CI 1.2 to 15.7). The BSRR remains an effective solution for acetabular revision surgery, providing consistent long-term outcomes. Its durability makes it a valuable tool in orthopaedic surgery, especially when managing significant bone loss.