Engh C Anderson, Egawa Hiroshi, Beykirch Sarah E, Hopper Robert H, Engh Charles A
Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA.
Clin Orthop Relat Res. 2007 Dec;465:150-4. doi: 10.1097/BLO.0b013e3181576097.
Periprosthetic osteolysis is a common cause for revision of total hip arthroplasty. When modular cementless acetabular components are stable, curettage and grafting of the osteo-lytic lesion while retaining the component are a good surgical option. Although the midterm outcome of this procedure is known, the quality of the surgical technique is not. We used preoperative and postoperative computed tomography to determine the percentage of periacetabular lesions that was grafted and the percentage of the lesion volume filled with an injectable bone graft substitute. We discovered, even with preoperative computed tomography reconstructions and surgical planning, four of 22 lesions were neglected at the time of surgery. In the 18 lesions that were treated, we were able to fill an average of 49% (range, 0-83%) of the lesion volume. These inconsistent results illustrate a need to further refine surgical techniques and instrumentation to treat one of the most common complications in total hip arthroplasty. Longer followup with repeat computed tomography scans or other imaging techniques would determine if the percentage of lesion fill has an effect on clinical outcome.
假体周围骨溶解是全髋关节置换翻修的常见原因。当模块化非骨水泥髋臼组件稳定时，在保留组件的同时刮除并移植骨溶解病变是一种不错的手术选择。虽然该手术的中期结果已知，但手术技术的质量尚不清楚。我们使用术前和术后计算机断层扫描来确定髋臼周围病变被移植的百分比以及病变体积中被可注射骨移植替代物填充的百分比。我们发现，即使有术前计算机断层扫描重建和手术规划，22个病变中有4个在手术时被遗漏。在接受治疗的18个病变中，我们平均能够填充病变体积的49%（范围为0 - 83%）。这些不一致的结果表明需要进一步完善手术技术和器械，以治疗全髋关节置换中最常见的并发症之一。通过重复计算机断层扫描或其他成像技术进行更长时间的随访将确定病变填充百分比是否对临床结果有影响。
