Cementless Titanium Fibermesh Cup in Cup-Cage Construct for Severe Acetabular Defect in Revision Total Hip Arthroplasty.

Abstract

Addressing bony defects in cases of severe acetabular bone loss remains challenging, and the cup-cage construct presents a potential solution. While tantalum cups have demonstrated favorable outcomes within the cup-cage construct, the efficacy of employing cup-cage constructs with titanium fibermesh remains to be elucidated. We conducted a retrospective, single-center study of patients who had Paprosky Type 3A or 3B acetabular bone loss and underwent cup-cage reconstruction with a cementless titanium fibermesh cup between 2011 and 2019, with a minimum 5-year follow-up period. Implant survivorship was assessed using Kaplan-Meier analyses, while clinical outcomes were evaluated, and sequential radiographic evaluations were performed to identify bone restoration processes. There were 29 patients included who had a mean age of 63 years (range, 41 to 82) and a mean follow-up duration of 125.7 months (range, 76 to 163). Cumulative implant survivorship was 97% at two years (95% CI [confidence interval]: 78 to 100) and 90% (95% CI: 71 to 98) at five and 10 years. Radiographically, all cases (29 of 29) demonstrated graft incorporation and osseointegration, with medial acetabular wall restoration observed in instances of pelvic discontinuity, and the hip center was effectively restored. Postoperatively, there were significant improvements in functional outcomes (Harris Hip Sore (HHS): preoperative 47.3 to postoperative 75.8; Oxford Hip Score (OHS): preoperative 21.0 to postoperative 37.8; Euro Quality-of-Life 5-dimension (EQ5D) index: preoperative 0.49 to postoperative 0.82, P < 0.001 for all). Notably, no revisions were required for aseptic loosening during the study period. The findings suggest that utilization of cup-cage constructs with cementless titanium fibermesh cups is a viable and cost-effective alternative to the use of tantalum cups in cup-cage constructs during revision THA. These results also suggest that the success of the cup-cage construct may be attributable to its fundamental concept rather than the specific use of tantalum cups.