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Year 2015, Volume: 49 Issue: 6, 597 - 605, 28.10.2015

Muhammed Demir , Yusuf Pirincci Muhammed Salih Fahri Erdogan , Nejat Guney

https://doi.org/10.3944/AOTT.2015.14.0281

Abstract

AMAÇ
Asetabular kemik yetmezliği ve asetabular komponent gevşemesi olan hastalardaki asetabular revizyonlarda, Asetabular Çatı halkası (AÇH) ve Burch-Schneider antiprotrusyo kafes (BSAPC) uygulamalarının orta ve uzun dönem sonuçları araştırıldı.
ÇALIŞMA PLANI
1988-2007 yılları arasında 51 hastaya 33 AÇH (25 kadın; ortalama yaş 64,9) ve 18 BSAPC (16 kadın; ortalama yaş 62,1) uygulandı. Tüm revizyonlarda greft kullanıldı. Bu hastalar retrospektif olarak incelendi. Kemik defektleri Amerikan Ortopedi Cerrahları Akademisi sınıflamasına göre tiplendirildi. Klinik değerlendirmede Harris skoru kullanıldı. Radyolojik olarak direkt grafilerde DeLee ve Charnley'e göre 3 bölgedeki radyolusent hatlar, implant bütünlükleri, osteointegrasyon ve heteretropik ossifikayon değerlendirildi.
BULGULAR
AÇH uygulamalarında ortalama 8,93±4,10 yıl (4-23) takiplerde başarı oranı %87,9 olup, 10. yıldaki kümülatif sağkalım oranı %91'dir. Harris skor ortalaması 40,10±2,49'dan ameliyat sonrası 83,70±8,98'e yükselmiştir (p<0,01). BSAPC uygulamalarında ortalama 7,06±2,39 yıl (4-12) takiplerde başarı oranı %83,3 olup 10. yıldaki kümülatif sağkalım oranı  %78'dir. Harris skor ortalaması 42,55'den ameliyat sonrası 73,86'ya yükselmiştir (p<0,01). AÇH uygulamalarındaki başarısızlıkların tamamı tip 3 defektlerde görüldü (p<0,05). Allogreft kullanılan 47 hastanın 40'ında osteointegrasyon gerçekleşti. Asetabular revizyonlarla beraber femoral komponent revizyonu geçirenlerde ve geçirmeyenlerdeki Harris skoru artışlarında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0,06). Birden fazla revizyona giren hastaların başarısızlık oranı ilk defa revizyona girenlere göre istatistiksel olarak anlamlı derecede fazla bulundu (p=0,008).
ÇIKARIMLAR
Kemik yetmezlikli asetabular revizyonlarda BSAPC ve AÇH'ların allogreftler ile kullanımının orta ve uzun dönemde sonuçları memnun edicidir. Bu implantlar greft osteointegrasyonunu sağlayarak kemik stoğunu arttırırlar ve daha sonra yapılacak revizyonları kolaylaştırırlar. Tip 1 ve tip 2 asetabular kemik defektlerinde AÇH, Tip 3 ve tip 4 defektlerde  BSAPC tercih edilmelidir.

 

DOI: 10.3944/AOTT.2015.14.0281
This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

Keywords

Asetabular revizyonlar;Asetabular kemik yetmezliğinde asetabular revizyonlar;Asetabular Çatı Halkası;Burch-Schneider Antiprotrüzyo Kafes.

References

  • Noordin S, Masri BA, Duncan CP, Garbuz DS. Acetabu- lar bone loss in revision total hip arthroplasty: principles and techniques. Instr Course Lect 2010;59:27–36.
  • D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bi- erbaum BF, Boettcher WG, et al. Classification and man- agement of acetabular abnormalities in total hip arthro- plasty. Clin Orthop Relat Res 1989;243:126–37.
  • Deirmengian GK, Zmistowski B, O’Neil JT, Hozack WJ. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am 2011;93:1842–52.
  • John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash, (Editörler), TheAdultHip. Nejat Güney, Ma- hir Mahiroğulları (Çeviri editörleri), Erişkin kalça, Cilt 2, Bölüm 94, Asetabular Revizyon Artroplastisinde Yapısal Allogreft Kullanımının Endikasyonları Tekniği ve Sonuçları, (s:1399),ikinci basım, Doğan Tıp Kitapevi (2008).
  • Paprosky WG, Martin EL. Structural acetabular allograft in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2002;31:481–4.
  • Amstutz HC, Ma SM, Jinnah RH, Mai L. Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res 1982;170:21–33.
  • Slooff TJ, Buma P, Schreurs BW, Schimmel JW, Huiskes R, Gardeniers J. Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop Relat Res 1996;324:108–15.
  • Marti RK, Schüller HM, Besselaar PP, Vanfrank Haas- noot EL. Results of revision of hip arthroplasty with ce- ment. A five to fourteen-year follow-up study. J Bone Joint Surg Am 1990;72:346–54.
  • Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res 2004;420:96–100.
  • Hallstrom BR, Golladay GJ, Vittetoe DA, Harris WH. Cementless acetabular revision with the Harris-Galante porous prosthesis. Results after a minimum of ten years of follow-up. J Bone Joint Surg Am 2004;86:1007–11.
  • Paxton ES Jr, Keeney JA, Maloney WJ, Clohisy JC. Large acetabular defects can be managed with cementless revision components. Clin Orthop Relat Res 2011;469:483–93.
  • Whaley AL, Berry DJ, Harmsen WS. Extra-large un- cemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 2001;83:1352–7.
  • Dearborn JT, Harris WH. Acetabular revision arthroplas- ty using so-called jumbo cementless components: an aver- age 7-year follow-up study. J Arthroplasty 2000;15:8–15.
  • Sporer SM, Paprosky WG. Acetabular revision using a trabecular metal acetabular component for severe acetabu- lar bone loss associated with a pelvic discontinuity. J Ar- throplasty 2006;21(6 Suppl 2):87–90.
  • Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS. Modular tantalum augments for acetabular de- fects in revision hip arthroplasty. Clin Orthop Relat Res 2009;467:199–205.
  • Van Kleunen JP, Lee GC, Lementowski PW, Nelson CL, Garino JP. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty 2009;24(6 Sup- pl):64–8.
  • Buttaro MA, Comba F, Pusso R, Piccaluga F. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res 2008;466:2482– 90.
  • Gilbody J, Taylor C, Bartlett GE, Whitehouse SL, Hubble MJ, Timperley AJ, et al. Clinical and radiographic out- comes of acetabular impaction grafting without cage re- inforcement for revision hip replacement: a minimum ten- year follow-up study. Bone Joint J 2014;96:188–94.
  • Schatzker J, Wong MK. Acetabular revision. The role of rings and cages. Clin Orthop Relat Res 1999;369:187–97.
  • Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P. A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic disconti- nuity. J Arthroplasty 2012;27:1057–63.
  • A. Hakan Eren. Harris hip score. Acta Orthop Traumatol Turc 1991;31: 285–8.
  • DeLee JG, Charnley J. Radiological demarcation of ce- mented sockets in total hip replacement. Clin Orthop Relat Res 1976;121:20–32.
  • Morsi E, Garbuz D, Gross AE. Revision total hip arthro- plasty with shelf bulk allografts. A long-term follow-up study. J Arthroplasty 1996;11:86–90.
  • Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Inci- dence and a method of classification. J Bone Joint Surg Am 1973;55:1629–32.
  • Schlegel UJ, Bitsch RG, Pritsch M, Clauss M, Mau H, Breusch SJ. Mueller reinforcement rings in acetabular re- vision: outcome in 164 hips followed for 2-17 years. Acta Orthop 2006;77:234–41.
  • Gurtner P, Aebi M, Ganz R. The acetabular roof cup in revision arthroplasty of the hip. [Article in German] Z Orthop Ihre Grenzgeb 1993;131:594–600.
  • Berry DJ, Müller ME. Revision arthroplasty using an anti- protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br 1992;74:711–5.
  • Symeonides PP, Petsatodes GE, Pournaras JD, Kapetanos GA, Christodoulou AG, Marougiannis DJ. The Effective- ness of the Burch-Schneider antiprotrusio cage for acetab- ular bone deficiency: five to twenty-one years’ follow-up. J Arthroplasty 2009;24:168–74.
  • Coscujuela-Mañá A, Angles F, Tramunt C, Casanova X. Burch-Schneider antiprotrusio cage for acetabular revi- sion: a 5- to 13-year follow-up study. Hip Int 2010;20 Suppl 7:112–8.
  • Paprosky WG, Perona PG, Lawrence JM. Acetabular de- fect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9:33–44.
  • Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br 1992;74:716–20.
  • Abolghasemian M, Sadeghi Naini M, Tangsataporn S, Lee P, Backstein D, Safir O, et al. Reconstruction of mas- sive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Joint J 2014;96:319–24.
  • S. Terry C, James HB. (Editörler) Campple’s Operative Orthopaedics. Mustafa B, Cemil Y, (Çeviri Editörleri) Bölüm 7, Kalça Artroplastisi (s:425) Güneş Tıp Kitape- vleri 2011.
  • Lamo-Espinosa J, Duart Clemente J, Díaz-Rada P, Pons- Villanueva J, Valentí-Nín JR. The Burch-Schneider anti- protrusio cage: medium follow-up results. Musculoskelet Surg 2013;97:31–7.
  • Philippe R, Gosselin O, Sedaghatian J, Dezaly C, Roche O, Sirveaux F, et al. Acetabular reconstruction using mor- selized allograft and a reinforcement ring for revision ar- throplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res 2012;98:129–37.
  • Krishnan KM, Longstaff L, Partington P. Acetabular re- construction using morcellised bone with ring support- -medium-term results at three to nine years. Acta Orthop Belg 2011;77:61–7.
  • Kjaersgaard-Andersen P, Hougaard K, Linde F, Christian- sen SE, Jensen J. Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis. Orthopedics 1990;13:1211–7.
  • Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Or- thop Relat Res 2002;405:46–53.
  • Wade FA, Rapuri VR, Parvizi J, Hozack WJ. Isolated ac- etabular polyethylene exchange through the anterolateral approach. J Arthroplasty 2004;19:498–500.
  • Bülbül M, Ayanoğlu S, Beytemür O, Gürkan V, Esenyel CZ, Gürbüz H. The relationship between morpho- metric parameters and Trendelenburg sign following the Hardinge incision. Acta Orthop Traumatol Turc 2010;44:124–6.

The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency

Year 2015, Volume: 49 Issue: 6, 597 - 605, 28.10.2015

Muhammed Demir , Yusuf Pirincci Muhammed Salih Fahri Erdogan , Nejat Guney

https://doi.org/10.3944/AOTT.2015.14.0281

Abstract

Objective: The purpose of this study was to investigate the mid-term and long-term effects of the acetabular roof ring (ARR) and Burch-Schneider anti-protrusio cage (BSAPC) in acetabular revision for patients with acetabular bone deficiency and acetabular component loosening.
Methods: Between 1988 and 2007, ARR revisions were performed in 51 patients (25 women; average age: 46.9 years) and BSAPC in 18 patients (16 women; average age: 62.1 years). Grafts were used in all revisions. The patients were evaluated retrospectively. The bone defects were classified according to the classification of the American Academy of Orthopaedic Surgeons (AAOS). Harris Hip Score (HHS) was used for clinical evaluation. Radiolucent lines, implant sizes, osseointegration, and heterotopic ossification in the 3 regions defined by DeLee and Charnley were evaluated radiologically.
Results: The success rate of ARR revisions after an average follow-up of 8.93±4.10 years (range: 4–23 years) was 87.9%, and the cumulative survival rate at year 10 postoperatively was 91%. Average HHS score increased to 83.70±8.98 postoperatively, from 40.10±2.49 preoperatively (p<0.01). The success rate of BSAPC revisions after an average follow-up of 7.06±2.39 years (range: 4–12 years) was 83.3%, and the cumulative survival rate was 78%. Average HHS score increased from 42.55 preoperatively to 73.86 postoperatively (p<0.01). All failures of ARR revisions occurred in type 3 defects (p<0.05). In 40 of the 47 patients in which an allograft was used, osseointegration occurred. No statistically significant difference was found between the increase in HHS scores of patients who underwent femoral component revision with acetabular revision and those who did not (p=0.06). Patients who underwent more than 1 revision had statistically significantly higher failure rates in comparison to patients undergoing revision for the first time (p=0.008).
Conclusion: The mid-term and long-term results of the use of ARR and BSAPC with allografts in bone deficient acetabular revisions are satisfactory. The implants facilitate graft osseointegration, increase the bone stock, and make future revisions easier. ARR should be preferred in type 1 and type 2 acetabular bone defects, while BSAPC should be preferred in type 3 and 4 defects.

Keywords

Acetabular revisions acetabular bone deficiency acetabular roof ring Burch-Schneider anti-protusio cage

References

  • Noordin S, Masri BA, Duncan CP, Garbuz DS. Acetabu- lar bone loss in revision total hip arthroplasty: principles and techniques. Instr Course Lect 2010;59:27–36.
  • D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bi- erbaum BF, Boettcher WG, et al. Classification and man- agement of acetabular abnormalities in total hip arthro- plasty. Clin Orthop Relat Res 1989;243:126–37.
  • Deirmengian GK, Zmistowski B, O’Neil JT, Hozack WJ. Management of acetabular bone loss in revision total hip arthroplasty. J Bone Joint Surg Am 2011;93:1842–52.
  • John J. Callaghan, Aaron G. Rosenberg, Harry E. Rubash, (Editörler), TheAdultHip. Nejat Güney, Ma- hir Mahiroğulları (Çeviri editörleri), Erişkin kalça, Cilt 2, Bölüm 94, Asetabular Revizyon Artroplastisinde Yapısal Allogreft Kullanımının Endikasyonları Tekniği ve Sonuçları, (s:1399),ikinci basım, Doğan Tıp Kitapevi (2008).
  • Paprosky WG, Martin EL. Structural acetabular allograft in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2002;31:481–4.
  • Amstutz HC, Ma SM, Jinnah RH, Mai L. Revision of aseptic loose total hip arthroplasties. Clin Orthop Relat Res 1982;170:21–33.
  • Slooff TJ, Buma P, Schreurs BW, Schimmel JW, Huiskes R, Gardeniers J. Acetabular and femoral reconstruction with impacted graft and cement. Clin Orthop Relat Res 1996;324:108–15.
  • Marti RK, Schüller HM, Besselaar PP, Vanfrank Haas- noot EL. Results of revision of hip arthroplasty with ce- ment. A five to fourteen-year follow-up study. J Bone Joint Surg Am 1990;72:346–54.
  • Della Valle CJ, Berger RA, Rosenberg AG, Galante JO. Cementless acetabular reconstruction in revision total hip arthroplasty. Clin Orthop Relat Res 2004;420:96–100.
  • Hallstrom BR, Golladay GJ, Vittetoe DA, Harris WH. Cementless acetabular revision with the Harris-Galante porous prosthesis. Results after a minimum of ten years of follow-up. J Bone Joint Surg Am 2004;86:1007–11.
  • Paxton ES Jr, Keeney JA, Maloney WJ, Clohisy JC. Large acetabular defects can be managed with cementless revision components. Clin Orthop Relat Res 2011;469:483–93.
  • Whaley AL, Berry DJ, Harmsen WS. Extra-large un- cemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 2001;83:1352–7.
  • Dearborn JT, Harris WH. Acetabular revision arthroplas- ty using so-called jumbo cementless components: an aver- age 7-year follow-up study. J Arthroplasty 2000;15:8–15.
  • Sporer SM, Paprosky WG. Acetabular revision using a trabecular metal acetabular component for severe acetabu- lar bone loss associated with a pelvic discontinuity. J Ar- throplasty 2006;21(6 Suppl 2):87–90.
  • Siegmeth A, Duncan CP, Masri BA, Kim WY, Garbuz DS. Modular tantalum augments for acetabular de- fects in revision hip arthroplasty. Clin Orthop Relat Res 2009;467:199–205.
  • Van Kleunen JP, Lee GC, Lementowski PW, Nelson CL, Garino JP. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty 2009;24(6 Sup- pl):64–8.
  • Buttaro MA, Comba F, Pusso R, Piccaluga F. Acetabular revision with metal mesh, impaction bone grafting, and a cemented cup. Clin Orthop Relat Res 2008;466:2482– 90.
  • Gilbody J, Taylor C, Bartlett GE, Whitehouse SL, Hubble MJ, Timperley AJ, et al. Clinical and radiographic out- comes of acetabular impaction grafting without cage re- inforcement for revision hip replacement: a minimum ten- year follow-up study. Bone Joint J 2014;96:188–94.
  • Schatzker J, Wong MK. Acetabular revision. The role of rings and cages. Clin Orthop Relat Res 1999;369:187–97.
  • Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P. A minimum of 10-year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic disconti- nuity. J Arthroplasty 2012;27:1057–63.
  • A. Hakan Eren. Harris hip score. Acta Orthop Traumatol Turc 1991;31: 285–8.
  • DeLee JG, Charnley J. Radiological demarcation of ce- mented sockets in total hip replacement. Clin Orthop Relat Res 1976;121:20–32.
  • Morsi E, Garbuz D, Gross AE. Revision total hip arthro- plasty with shelf bulk allografts. A long-term follow-up study. J Arthroplasty 1996;11:86–90.
  • Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Inci- dence and a method of classification. J Bone Joint Surg Am 1973;55:1629–32.
  • Schlegel UJ, Bitsch RG, Pritsch M, Clauss M, Mau H, Breusch SJ. Mueller reinforcement rings in acetabular re- vision: outcome in 164 hips followed for 2-17 years. Acta Orthop 2006;77:234–41.
  • Gurtner P, Aebi M, Ganz R. The acetabular roof cup in revision arthroplasty of the hip. [Article in German] Z Orthop Ihre Grenzgeb 1993;131:594–600.
  • Berry DJ, Müller ME. Revision arthroplasty using an anti- protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br 1992;74:711–5.
  • Symeonides PP, Petsatodes GE, Pournaras JD, Kapetanos GA, Christodoulou AG, Marougiannis DJ. The Effective- ness of the Burch-Schneider antiprotrusio cage for acetab- ular bone deficiency: five to twenty-one years’ follow-up. J Arthroplasty 2009;24:168–74.
  • Coscujuela-Mañá A, Angles F, Tramunt C, Casanova X. Burch-Schneider antiprotrusio cage for acetabular revi- sion: a 5- to 13-year follow-up study. Hip Int 2010;20 Suppl 7:112–8.
  • Paprosky WG, Perona PG, Lawrence JM. Acetabular de- fect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994;9:33–44.
  • Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br 1992;74:716–20.
  • Abolghasemian M, Sadeghi Naini M, Tangsataporn S, Lee P, Backstein D, Safir O, et al. Reconstruction of mas- sive uncontained acetabular defects using allograft with cage or ring reinforcement: an assessment of the graft’s ability to restore bone stock and its impact on the outcome of re-revision. Bone Joint J 2014;96:319–24.
  • S. Terry C, James HB. (Editörler) Campple’s Operative Orthopaedics. Mustafa B, Cemil Y, (Çeviri Editörleri) Bölüm 7, Kalça Artroplastisi (s:425) Güneş Tıp Kitape- vleri 2011.
  • Lamo-Espinosa J, Duart Clemente J, Díaz-Rada P, Pons- Villanueva J, Valentí-Nín JR. The Burch-Schneider anti- protrusio cage: medium follow-up results. Musculoskelet Surg 2013;97:31–7.
  • Philippe R, Gosselin O, Sedaghatian J, Dezaly C, Roche O, Sirveaux F, et al. Acetabular reconstruction using mor- selized allograft and a reinforcement ring for revision ar- throplasty with Paprosky type II and III bone loss: survival analysis of 95 hips after 5 to 13 years. Orthop Traumatol Surg Res 2012;98:129–37.
  • Krishnan KM, Longstaff L, Partington P. Acetabular re- construction using morcellised bone with ring support- -medium-term results at three to nine years. Acta Orthop Belg 2011;77:61–7.
  • Kjaersgaard-Andersen P, Hougaard K, Linde F, Christian- sen SE, Jensen J. Heterotopic bone formation after total hip arthroplasty in patients with primary or secondary coxarthrosis. Orthopedics 1990;13:1211–7.
  • Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Or- thop Relat Res 2002;405:46–53.
  • Wade FA, Rapuri VR, Parvizi J, Hozack WJ. Isolated ac- etabular polyethylene exchange through the anterolateral approach. J Arthroplasty 2004;19:498–500.
  • Bülbül M, Ayanoğlu S, Beytemür O, Gürkan V, Esenyel CZ, Gürbüz H. The relationship between morpho- metric parameters and Trendelenburg sign following the Hardinge incision. Acta Orthop Traumatol Turc 2010;44:124–6.
There are 40 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Muhammed Demir

Yusuf Pirincci This is me

Muhammed Salih This is me

Fahri Erdogan

Nejat Guney This is me

Publication Date October 28, 2015
Published in Issue Year 2015 Volume: 49 Issue: 6

Cite

APA Demir, M., Pirincci, Y., Salih, M., Erdogan, F., et al. (2015). The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency. Acta Orthopaedica Et Traumatologica Turcica, 49(6), 597-605. https://doi.org/10.3944/AOTT.2015.14.0281
AMA Demir M, Pirincci Y, Salih M, Erdogan F, Guney N. The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency. Acta Orthopaedica et Traumatologica Turcica. October 2015;49(6):597-605. doi:10.3944/AOTT.2015.14.0281
Chicago Demir, Muhammed, Yusuf Pirincci, Muhammed Salih, Fahri Erdogan, and Nejat Guney. “The Midterm and Long-Term Effects of Acetabular Roof Ring and Burch-Schneider Anti-Protusio Cages in Acetabular Revisions for Patients With Acetabular Bone Deficiency”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 6 (October 2015): 597-605. https://doi.org/10.3944/AOTT.2015.14.0281.
EndNote Demir M, Pirincci Y, Salih M, Erdogan F, Guney N (October 1, 2015) The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency. Acta Orthopaedica et Traumatologica Turcica 49 6 597–605.
IEEE M. Demir, Y. Pirincci, M. Salih, F. Erdogan, and N. Guney, “The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 6, pp. 597–605, 2015, doi: 10.3944/AOTT.2015.14.0281.
ISNAD Demir, Muhammed et al. “The Midterm and Long-Term Effects of Acetabular Roof Ring and Burch-Schneider Anti-Protusio Cages in Acetabular Revisions for Patients With Acetabular Bone Deficiency”. Acta Orthopaedica et Traumatologica Turcica 49/6 (October 2015), 597-605. https://doi.org/10.3944/AOTT.2015.14.0281.
JAMA Demir M, Pirincci Y, Salih M, Erdogan F, Guney N. The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency. Acta Orthopaedica et Traumatologica Turcica. 2015;49:597–605.
MLA Demir, Muhammed et al. “The Midterm and Long-Term Effects of Acetabular Roof Ring and Burch-Schneider Anti-Protusio Cages in Acetabular Revisions for Patients With Acetabular Bone Deficiency”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 6, 2015, pp. 597-05, doi:10.3944/AOTT.2015.14.0281.
Vancouver Demir M, Pirincci Y, Salih M, Erdogan F, Guney N. The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency. Acta Orthopaedica et Traumatologica Turcica. 2015;49(6):597-605.