Murawski, Karol;
(2023)
The Management of Massive
Acetabular Defects in Revision THR:
Pre-operative Planning, Implant Design and Post-operative assessment of Implant Position and Fixation.
Masters thesis (M.Phil), UCL (University College London).
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Abstract
Total hip arthroplasty (THA) is a successful treatment for end-stage osteoarthritis of the hip. However, treatment of massive acetabular defects remains extremely complex and is increasingly needed with the growing number of revisions. Custom-made acetabular implants (CMAI) used to treat Paprosky type 3 and pelvic discontinuity show clinical improvement but are associated with a high complication rate. Clinical relevance in their monitoring is not well understood. The thesis reports the implant motion over time of CMAI. Twenty patients received a CMAI between 2016 and 2019. Two follow up CT scans at a mean of 17 and 38 months were analysed with a peer-reviewed CT motion analysis (CTMA) method to measure implant migration in six degrees of freedom. Implants show significant initial migration, which is reduced in the second timepoint in the posterior (p = 0.05) and superior directions (p<0.01). None of the implants are indicated for instability suggesting an alternate stabilisation mechanism. The thesis also investigates the accuracy of CTMA and its dependence on registration and changes to bone anatomy which may result from bone remodelling. Precision achieved was lower than other studies with conventional implants. 99% confidence interval of registration accuracy was submillimetre. Pelvis configuration helped improve the measurement accuracy. The benefits of using a 3D bone density quality map for screw position planning were investigated. Four patients with large acetabular defects receiving a CMAI underwent a two-stage surgery, with a CT scan obtained without an implant. 3D Bone density models were developed and compared to the post-operatively achieved screw positions. The thesis investigated areas of intense research of the post-operative evaluation and pre-surgical planning of CMAI. The migration study was the first using to time-points to quantify the mid-term migration pattern of a CMAI. It also presents the first study assessing the CT registration quality in-line with ISO standards. Novel techniques for CMAI design were investigated.
| Type: | Thesis (Masters) |
|---|---|
| Qualification: | M.Phil |
| Title: | The Management of Massive Acetabular Defects in Revision THR: Pre-operative Planning, Implant Design and Post-operative assessment of Implant Position and Fixation |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10187958 |
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