Callaghan John J, Parvizi Javad, Novak Clifford C, Bremner Barron, Shrader Wade, Lewallen David G, Johnston Richard C, Goetz Devon D
Department of Orthopaedic Surgery, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA.
J Bone Joint Surg Am. 2004 Oct;86(10):2206-11. doi: 10.2106/00004623-200410000-00011.
Constrained acetabular components have been used to treat hips with recurrent instability following total hip arthroplasty and hips that demonstrate instability during revision surgery. In such hips, when a secure cementless acetabular shell is present, the surgeon can cement a constrained liner into the existing shell. The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell.
Between 1988 and 2000, constrained liners were cemented into thirty-one well-fixed cementless acetabular shells at three centers. The average age of the patients at the time of the index surgery was 72.1 years, and the indications for the procedure were recurrent hip instability in sixteen hips and intraoperative instability in fifteen hips. The patients were evaluated with respect to the clinical outcome and radiographic evidence of shell loosening and osteolysis.
At an average duration of follow-up of 3.9 years, twenty-nine liners (94%) were securely fixed in the cementless shells and two constrained liners had failed. One liner failed because it separated from the cement, and one failed because of fracture of the capturing mechanism. Both hips were successfully revised with another cemented tripolar constrained liner. No acetabular component demonstrated radiographic evidence of progressive loosening or osteolysis.
A constrained tripolar liner cemented into a secure, well-positioned cementless acetabular shell provides stability and durability at short-term follow-up. Careful attention to the preparation of the liner, the sizing of the component, and the cementing technique are likely to reduce the failure of this construct, which can be used for difficult cases of total hip instability.
在全髋关节置换术后出现反复不稳定的髋关节以及翻修手术中表现出不稳定的髋关节治疗中，使用了限制性髋臼组件。在这类髋关节中，当存在稳固的非骨水泥髋臼杯时，外科医生可将限制性衬垫用骨水泥固定到现有的髋臼杯中。本研究的目的是评估将三极限制性衬垫用骨水泥固定到位置良好且固定牢固的非骨水泥髋臼杯中的这项技术的临床和影像学结果。
1988年至2000年期间，在三个中心将限制性衬垫用骨水泥固定到31个位置良好且固定牢固的非骨水泥髋臼杯中。初次手术时患者的平均年龄为72.1岁，手术指征为16例髋关节反复不稳定和15例髋关节术中不稳定。对患者进行了临床结果以及髋臼杯松动和骨溶解的影像学证据评估。
平均随访3.9年时，29个衬垫（94%）牢固固定在非骨水泥髋臼杯中，2个限制性衬垫失败。1个衬垫因与骨水泥分离而失败，1个因固定装置断裂而失败。这两个髋关节均成功用另一个骨水泥固定的三极限制性衬垫进行了翻修。没有髋臼组件显示出影像学上的渐进性松动或骨溶解证据。
在短期随访中，将三极限制性衬垫用骨水泥固定到稳固、位置良好的非骨水泥髋臼杯中可提供稳定性和耐用性。仔细注意衬垫的准备、组件的尺寸选择和骨水泥固定技术可能会减少这种结构的失败，该结构可用于全髋关节不稳定的困难病例。
