The modern Burch-Schneider antiprotrusio cage for the treatment of acetabular defects: is it still an option? A systematic review

BACKGROUND A number of papers have been published about the clinical performance of modern rough-blasted titanium Burch-Schneider antiprotrusio cages (BS-APCs) for the treatment of acetabular bone defects. However, no systematic review of the literature has been published to date. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications using keywords pertinent to Burch-Schneider antiprotrusio cage, revision THA, and clinical outcomes. RESULTS 8 articles were found to be suitable for inclusion in the present study in which 374 cases (370 patients) had been treated with modern BS-APCs. Most acetabular bone defects were type 3 according to the Paprosky classification (type 2C: 18.1%, 3A: 51%, and 3B: 28.9%). The overall re-revision rate for the 374 acetabular reconstructions with modern BS-APCs was 11.5% (43 cases). The short-term survival rate of the modern BS-APC construct was 90.6% (339 out of 374 cases), while the mid-term survival rate was 85.6% (320 out of 374 cases), and the long-term survival rate 62% (54 out of 87 cases). The most common reasons for revision were aseptic loosening (5.6%), periprosthetic joint infection (3.8%), dislocation (2.7%), and acetabular periprosthetic fracture (1.9%). CONCLUSIONS There was moderate quality evidence to show that the use of modern rough blasted titanium BS-APCs in cases of acetabular bone loss has an unacceptably high failure rate (38%). Given that antiprotrusio cages do not provide any biological fixation, we would not recommend the routine use of modern BS-APCs in complex revision THA cases. By contrast, the satisfactory short- to mid-term outcome of modern BS-APCs in combination with their low cost compared to highly porous acetabular implants, make us feel that BS-APCs might still be used in selected elderly or low-demand patients without severe superomedial acetabular bone loss.

[1]  M. Alexiades,et al.  Outcomes of Acetabular Reconstructions for the Management of Chronic Pelvic Discontinuity: A Systematic Review. , 2019, The Journal of arthroplasty.

[2]  R. Malhotra,et al.  Cup-Cage Construct Using Porous Cup with Burch-Schneider Cage in the Management of Complex Acetabular Fractures , 2019, Hip & pelvis.

[3]  M. Bostrom,et al.  Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review. , 2019, The Journal of arthroplasty.

[4]  G. Gosheger,et al.  Dislocation rates with combinations of anti-protrusio cages and dual mobility cups in revision cases: Are we safe? , 2019, PloS one.

[5]  A. Capone,et al.  Long-term results of isolated acetabular revisions with reinforcement rings: a 10- to 15-year follow-up , 2018, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[6]  L. Kerboull,et al.  Acetabular reinforcement rings associated with allograft for severe acetabular defects , 2018, International Orthopaedics.

[7]  J. Vaquero,et al.  Clinical and radiological outcomes of trabecular metal systems and antiprotrusion cages in acetabular revision surgery with severe defects: a comparative study , 2018, International Orthopaedics.

[8]  A. Marx,et al.  Major Acetabular Defects Treated with the Burch-Schneider Antiprotrusion Cage and Impaction Bone Allograft in a Large Series: A 5- to 7- Year Follow-up Study , 2016, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[9]  Jun-Wen Wang,et al.  Use of the Burch–Schneider cage and structural allografts in complex acetabular deficiency: 3‐ to 10‐year follow up , 2015, The Kaohsiung journal of medical sciences.

[10]  I. Ilyas,et al.  Revision of type III and type IVB acetabular defects with Burch-Schneider anti-Protrusio cages. , 2015, The Journal of arthroplasty.

[11]  M. Whitehouse,et al.  Mortality after total hip replacement surgery , 2014, Bone & joint research.

[12]  M. A. Miranda,et al.  Use of jumbo cups for revision of acetabulae with large bony defects. , 2010, The Journal of arthroplasty.

[13]  O. Bortolami,et al.  A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. , 2012, The Journal of arthroplasty.

[14]  M. Cabanela,et al.  Cementless acetabular revision: past, present, and future , 2011, International Orthopaedics.

[15]  Paul T. H. Lee,et al.  Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty , 2010, Clinical orthopaedics and related research.

[16]  P. Devane,et al.  A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty. , 2009, The Journal of arthroplasty.

[17]  D. Backstein,et al.  Trabecular Metal™ Cups for Acetabular Defects With 50% or Less Host Bone Contact , 2009, Clinical orthopaedics and related research.

[18]  J. Pournaras,et al.  The Effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years' follow-up. , 2009, The Journal of arthroplasty.

[19]  Centre for Evidence-based Medicine website gets revamp , 2009, Evidence-Based Dentistry.

[20]  D. Regis,et al.  Long-term results of anti-protrusion cage and massive allografts for the management of periprosthetic acetabular bone loss. , 2008, The Journal of arthroplasty.

[21]  S. Kurtz,et al.  Future clinical and economic impact of revision total hip and knee arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[22]  S. Sambandam,et al.  Analysis of methodological deficiencies of studies reporting surgical outcome following cemented total-joint arthroplasty of trapezio-metacarpal joint of the thumb , 2007, International Orthopaedics.

[23]  D. Oakes,et al.  Impaction Bone Grafting for Revision Hip Arthroplasty: Biology and Clinical Applications , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[24]  P. Katz,et al.  Hospital resource utilization for primary and revision total hip arthroplasty. , 2005, The Journal of bone and joint surgery. American volume.

[25]  J. Ong,et al.  SURFACE ROUGHNESS OF TITANIUM ON BONE MORPHOGENETIC PROTEIN‐2 TREATED OSTEOBLAST CELLS IN VITRO , 1997, Implant dentistry.

[26]  D Buser,et al.  Influence of surface characteristics on bone integration of titanium implants. A histomorphometric study in miniature pigs. , 1991, Journal of biomedical materials research.