Abstract
Different techniques have been described to address massive bone loss of the acetabulum in revision hip surgery. aMace has gained popularity as it provides customization aiming to restore hip centre and provide good initial stability in cases of large non-contained defects. It takes into account quality of host bone. Its porous defect filling scaffold provides an excellent surface for osteointegration.
Our aim was to assess the short and mid-term outcomes of patients who underwent revision surgery using aMace system.
Ethical approval was obtained. A retrospective study included all patients who had aMace between June 2013 and October 2022 allowing for a minimum of 12-months follow-up. Patients’ demographics, indication, bone-loss severity, reconstruction details, re-operation, complications, mortality, pain and function were assessed.
52 cases were performed by 13 surgeons with median 51 months follow-up. Median age was 72.7 years. 86.5% were female. Average BMI was 25.3. Average ASA grade was 3.
65% were classified as Paprosky IIIB and 32% were IIIA.
73% were found to have poor bone quality on CT. Main indication for aMace was massive bone loss/discontinuity secondary to aseptic loosening in 88.5%.
77% underwent single-stage revision. 53.8% had 2 or more previous revisions. 71% underwent stem revision in the same setting. 77% received a dual mobility bearing.
Re-operation rate was 5.7% for instability and femoral PPF. LLD was reported in 9.6%.
Permanent Sciatic nerve palsy occurred in 3.8% of the cases.
30-days mortality was 1.9%.
Statistically significant post-op improvements in pain and mobility were reported (p<0.001). None of the acetabular components have been revised.
Our study shows satisfactory surgical outcomes with a relatively low complication rate and significant pain and mobility improvements in the early to mid-term stages.
We recommend these costly cases to be done in highly specialist centres adopting MDT approach.
