Acetabular reconstruction with the Burch-Schneider ring: an EBRA analysis of 40 cup revisions.
BACKGROUND
Reconstruction of the bone stock and fixation of the implant remain challenging problems in revision surgery. In this retrospective study, we wanted to gain information on initial stability and wear after revision with the Burch-Schneider ring.


METHODS
Between 1994 and 1998, we performed 70 reconstructions of the acetabulum with a Burch-Schneider ring in revision arthroplasty. 63 patients could be followed up clinically and radiographically. 40 cups were suitable for EBRA measurements whereas migration and wear could not be assessed by this method in 23 cases due to lack of comparability of pelvic radiographs. The mean follow-up time was 4.7 years.


RESULTS
2 cups were re-revised and 14 cups had breakage or changes of position of the screws. 30 cups showed detectable migration and 18 cups detectable wear. The mean migration was 2.8 mm and the mean wear rate was 0.12 mm/year. 16 cups had detectable migration after 1 year; 11 of these 16 continued to migrate and 9 of them had screw breakage. Both re-revisions showed early migration. Early migration correlated with later screw breakage and the overall migration correlated with wear. The only risk factor found for early migration was the wear rate.


CONCLUSIONS
The Burch-Schneider ring is an established and reliable implant for cup revision with good clinical results, but it seems to be difficult to maintain intraoperative stability. The implants with continuous migration may lead to late clinical failure and require further observation. Wear may contribute to migration and resorption of the bone graft.
Ilchmann
Thomas
T
Department of Orthopedics, Kantonsspital Liestal, Switzerland. thomas.ilchmann@ksli.ch
Gelzer
Jan Philipp
JP
Winter
Eugen
E
Weise
Kuno
K
D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D020099:Coated Materials, Biocompatible; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D015207:Osteoarthritis, Hip / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies
D020099:Coated Materials, Biocompatible