Schreurs B Willem, Busch Vincent J J F, Welten Marianne L, Verdonschot Nico, Slooff Tom J J H, Gardeniers Jean W M
Department of Orthopaedics, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Bone Joint Surg Am. 2004 Nov;86(11):2385-92. doi: 10.2106/00004623-200411000-00004.
Acetabular bone deficiency can present a challenge during total hip arthroplasty, especially in young patients. The purpose of the present study was to evaluate the long-term clinical and radiographic outcomes of primary and revision acetabular reconstruction with use of an impaction bone-grafting technique and a cemented polyethylene cup in young patients who had preexisting acetabular bone deficiency.
Forty-two consecutive acetabular reconstructions were performed in thirty-seven patients who were younger than fifty years old (average, 37.2 years old). The impaction bone-grafting technique was used for twenty-three primary and nineteen revision acetabular reconstructions. Twenty-eight patients (thirty-one hips) were available for review after a minimum duration of follow-up of fifteen years. Clinical and radiographic results were assessed, and survivorship analysis was performed with the Kaplan-Meier method.
Eight hips were revised at a mean of twelve years (range, three to twenty-one years) after a primary reconstruction (four hips) or revision reconstruction (four hips). The revision was performed because of aseptic loosening of the acetabular component in four hips and because of culture-proven septic loosening in two. Two additional cups (both in hips that had had a revision reconstruction) were revised, during revision of the femoral stem, because of wear (one hip) or because of persistent intraoperative instability (one hip). Twenty-eight hips (in twenty-five patients) had retention of the acetabular component for a minimum of fifteen years. The mean Harris hip score for that group was 89 points. Twenty-six of these twenty-eight hips had no or slight pain. Kaplan-Meier analysis revealed a twenty-year survival rate of 80% (95% confidence interval, 67% to 94%) with acetabular revision for any reason as the end point and of 91% (95% confidence interval, 80% to 100%) with acetabular revision because of aseptic loosening as the end point.
Acetabular reconstruction with use of impaction bone-grafting and a cemented polyethylene cup is a reliable and durable technique that is associated with good long-term results in young patients with acetabular bone-stock defects.
髋臼骨缺损在全髋关节置换术中可能带来挑战，尤其是在年轻患者中。本研究的目的是评估在已有髋臼骨缺损的年轻患者中，采用打压植骨技术和骨水泥固定聚乙烯髋臼杯进行初次和翻修髋臼重建的长期临床和影像学结果。
对37例年龄小于50岁（平均37.2岁）的患者连续进行了42次髋臼重建。其中23例初次髋臼重建和19例翻修髋臼重建采用了打压植骨技术。在至少随访15年后，28例患者（31髋）可供评估。评估临床和影像学结果，并采用Kaplan-Meier方法进行生存率分析。
初次重建（4髋）或翻修重建（4髋）后，平均12年（范围3至21年）有8髋进行了翻修。翻修的原因是4髋髋臼假体无菌性松动，2髋经培养证实为感染性松动。另外2个髋臼杯（均在进行过翻修重建的髋关节中）在股骨柄翻修时因磨损（1髋）或术中持续不稳定（1髋）而进行了翻修。28髋（25例患者）髋臼假体保留至少15年。该组患者Harris髋关节平均评分为89分。这28髋中有26髋无疼痛或仅有轻微疼痛。Kaplan-Meier分析显示，以任何原因进行髋臼翻修为终点时，20年生存率为80%（95%置信区间，67%至94%）；以无菌性松动导致的髋臼翻修为终点时，20年生存率为91%（95%置信区间，80%至100%）。
采用打压植骨和骨水泥固定聚乙烯髋臼杯进行髋臼重建是一种可靠且持久的技术，在有髋臼骨量缺损的年轻患者中可获得良好的长期效果。
