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This retrospective study investigated the impact of acetabular bone loss severity (Paprosky and Saleh classifications) on center of rotation (COR) restoration and its influence on clinical outcomes (HHS, WOMAC, SF-12) in 117 patients undergoing acetabular revision THA. The study found that while the severity of the acetabular defect was associated with the ability to accurately reconstruct the COR, restoration of the COR did not significantly impact functional outcomes or complication rates at a median follow-up of 41 months. The authors suggest prioritizing stable fixation and bone preservation over perfect anatomic COR restoration.
In acetabular revision THA, achieving perfect anatomical restoration of the hip center of rotation does not appear to improve functional outcomes or reduce complications compared to prioritizing stable fixation and bone preservation.
Background Acetabular revision is a challenging procedure, especially in patients with large defects. This study aimed to evaluate how the severity of acetabular bone loss influences reconstruction of the center of rotation (COR) and how the COR influences clinical outcomes and patient-reported outcome measures (PROMs). Methods Patients who underwent acetabular revision at a tertiary hospital from January 2013 to December 2018 were included. Patients were grouped according to the Paprosky and Saleh classifications. To determine the COR, we applied the method described by Fessy. The Harris Hip Score (HHS), Western Ontario McMaster Arthritis Index (WOMAC) and Short Form 12 (SF-12) were used to determine clinical outcomes and PROMs at a median of 41 months of follow-up. A total of 117 acetabular revisions were performed. The Paprosky classification was I for 54 acetabular defects (46.15 %); II for 36 acetabular defects (30.76 %); and III for 27 acetabular defects (23.07 %). The Saleh classification was as follows: I for 54 (46.15 %); II for 26 (22.22 %); III for 19 (16.23 %); IV for 16 (13.67 %) and V for 2 (1,7 %) acetabular defects. Results The percentage of patients who achieved an appropriate COR was 60.1 % according to the Fessy method. This method showed a statistically significant association between the severity of the acetabular defect and the ability to accurately reconstruct the center of rotation. Similarly, no differences were observed in patients' functional outcomes (HHS, WOMAC, and SF-12 scores) based on whether the hip center of rotation was restored. Likewise, no differences were found in complication rates regardless of COR restoration or the degree of bone loss. Conclusion These findings suggest that, in complex acetabular revisions, prioritizing stable fixation and bone preservation rather than perfect anatomic restoration of the center of rotation does not adversely affect functional outcomes.
