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Acetabular Reconstruction with Porous Tantalum Implant Constructs in Total Hip Arthroplasty for Periacetabular Tumors

Fazel A. Khan, MD ( n ), Franklin H. Sim, MD (a-Dupuy, Zimmer, Stryker),
David G. Lewallen, MD (a- Zimmer, Dupuy, Stryker, c-Zimmer, e-Zimmer, FIOS, Orthosonics)
Mayo Clinic, Rochester, MN
Acetabular reconstruction during total hip arthroplasty (THA) for periacetabular tumors may be challenging due to bone loss and prior irradiation. Given their reported success in other scenarios involving bone loss and irradiation, we hypothesized that porous tantalum acetabular implants might also be successful for periacetabular tumors.
A joint registry search identified 16 patients with periacetabular tumors who underwent THA with porous tantalum implants with minimum 2-year follow-up (for surviving patients). Acetabular reconstruction followed tumor curettage and consisted of an uncemented porous tantalum shell. When required for mechanical stability, additional screws, porous tantalum augments, pelvic plate, and/or a cup-cage construct was added. Clinical and radiographic results were reviewed.
14/16 patients underwent primary THA. 14/16 patients had prior periacetabular irradiation. Mean survival was 2.4 years. Mean follow-up length for all surviving patients was 27.4 months (20.8 overall). There were 4 Class I, 3 Class II, and 7 Class III Harrington defects. Revision cases included 1 Type 2 and 1 Type 4 AAOS defects. Acetabular reconstruction consisted of cup only (4 cases), cup+plate (1), cup+cage (5), cup+augment+plate (1), cup+augment (4), and cup+augment+cage (1). At latest follow-up, pain was improved in 10 patients, unchanged in 3; ambulation was improved in 10 patients, unchanged in 2, worsened in 1 (3 patients unknown); mean Harris Hip Score improved from 41 to 82. No cases of radiographic loosening or progressive radiolucent lines occurred.
At short-term follow-up, porous tantalum acetabular implants, appropriately augmented to achieve sound initial mechanical stability, appears effective in THA for periacetabular tumors. Longer term data is needed.

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