Fan Cheng-Yu, Chen Wei-Ming, Lee Ocar K, Huang Ching-Kuei, Chiang Chao-Ching, Chen Tain-Hsiung
Department of Orthopaedics, Taipei Medical University Hospital, 250 Wu-Xin Street, Taipei City, Taiwan.
Arch Orthop Trauma Surg. 2008 Aug;128(8):809-13. doi: 10.1007/s00402-007-0492-7. Epub 2007 Nov 6.
Variable degrees of bony deficiencies often complicate revisional arthrolasties of acetabular components and represent challenges to orthopedic surgeons. Many solutions exist and cementless jumbo cup reconstruction had been proven to be a feasible and successful method. Our study aimed to access the results of these cementless giant cups for managing acetabular bony defect at one institute.
Between March 2000 and March 2003, 47 revisions of the failed acetabular components using the so-called "Jumbo Acetabular Cups" were enrolled in our study. All cases were followed for at least 4 years. We defined the size of the jumbo cups for the Asians to be of an outside diameter of 64 mm for men and 60 mm for women, which were 2 mm smaller than the commonly used definition in the Western countries. The radiographic outcomes and the migration of hip centers were analyzed. The endurance of these giant sockets was estimated by the Kaplan-Meier analysis.
After a mean follow-up of 65 months, only three implant failures requiring re-revision were identified. The estimated 5-year survival rate according to the Kaplan-Meier analysis was 94.5%. Radiographic analysis demonstrated an improvement of vertical hip center from 31 to 27 mm proximal to the interteardrop line. Eight (17%) cups exhibited radiolucent line around the bone-prosthesis interface but did not attenuate implant instability. The complication rate was not high. Dislocation happened in five (11%) patients. One deep infection was successfully reconstructed in stage surgeries after eradication of the infection.
With the aid of novel implant-coating technique and materials, jumbo cup reconstruction can achieve stability and longevity through an adequate peripheral ring-contact, regardless of inadequate implant to host bone contact. We believe that this is a reliable and easily performed reconstruction for acetabular defect.
不同程度的骨缺损常使髋臼假体翻修手术变得复杂，这对骨科医生来说是个挑战。有多种解决方案，无骨水泥超大臼杯重建已被证明是一种可行且成功的方法。我们的研究旨在评估在一家机构使用这些无骨水泥超大臼杯处理髋臼骨缺损的结果。
2000年3月至2003年3月期间，我们对47例使用所谓“超大髋臼杯”翻修失败髋臼假体的病例进行了研究。所有病例均随访至少4年。我们将亚洲人使用的超大臼杯尺寸定义为男性外径64毫米，女性外径60毫米，比西方国家常用的定义小2毫米。分析了影像学结果和髋关节中心的移位情况。通过Kaplan-Meier分析评估这些超大臼杯的耐用性。
平均随访65个月后，仅发现3例需要再次翻修的植入失败病例。根据Kaplan-Meier分析，估计的5年生存率为94.5%。影像学分析显示髋关节中心在泪滴线近端从31毫米改善至27毫米。8个（17%）臼杯在骨-假体界面周围出现透亮线，但未减弱植入物的稳定性。并发症发生率不高。5例（11%）患者发生脱位。1例深部感染在感染根除后的分期手术中成功重建。
借助新型植入物涂层技术和材料，超大臼杯重建可通过充分的周边环形接触实现稳定性和长期耐用性，无论植入物与宿主骨的接触是否充分。我们认为这是一种可靠且易于实施的髋臼缺损重建方法。
