Köster Georg, Rading Sabine
Abteilung Orthopädische Chirurgie und Traumatologie, Chirurgisch-Orthopädische Fachklinik Lorsch, Waldstrasse 13, 64653 Lorsch, Germany.
Arch Orthop Trauma Surg. 2009 May;129(5):603-8. doi: 10.1007/s00402-008-0624-8. Epub 2008 Apr 1.
Failure of acetabular components often leads to bone loss with extensive elongated defects in the surrounding bone. In these cases, reconstruction is challenging and stable fixation of the revision implant difficult. The use of an oblong cup has been described as an option for acetabular reconstruction in such revisions. We report the first long-term results obtained with this implant to date.
Fifty-six longitudinal oblong revision cups (LOR) were evaluated clinically and radiologically after a follow-up of 8-12 years (average 9 years). The defects treated with the LOR cup ranged from Paprosky type 1-3. Allogenic cancellous bone chips were additionally used in 31 reconstructions to fill cavitary defects.
Based on radiological criteria, 50 acetabular implants underwent osseointegration without any definitive signs of loosening; 2 consistently exhibited zonal radiolucent lines that were always smaller than 2 mm, 1 migrated by around 3 mm. None of these cases exhibited any clinical symptoms. In 11 cases where acetabular defects manifested postoperatively, 8 were remodeled completely and 3 partially at final follow-up. Three revision implants migrated farther than 5 mm and had to be revised before 32-month follow-up. In addition, 1 septic implant failure occurred. After an average follow-up of 9 years, 93% of the investigated implants remained in situ without further revision and 95% without aseptic implant failure.
This 12-year clinical study demonstrates that the LOR cup offers a successful concept for the revision of failed acetabular components that also promotes the biological reconstruction of bony defects. Compared with other methods with similarly long follow-ups, our long-term results prove this procedure has a very low rate of revision and aseptic implant failure.
髋臼假体失败常常导致骨质流失，周围骨出现广泛的长形缺损。在这些情况下，重建具有挑战性，翻修植入物的稳定固定也很困难。椭圆形髋臼杯已被描述为这类翻修手术中髋臼重建的一种选择。我们报告了迄今为止使用这种植入物获得的首个长期结果。
对56个纵向椭圆形翻修髋臼杯（LOR）进行了临床和放射学评估，随访时间为8 - 12年（平均9年）。使用LOR杯治疗的缺损范围为Paprosky 1 - 3型。在31例重建中额外使用了同种异体松质骨碎片来填充腔隙性缺损。
根据放射学标准，50个髋臼植入物实现了骨整合，没有任何明确的松动迹象；2个始终表现出小于2毫米的带状透亮线，1个移位约3毫米。这些病例均未出现任何临床症状。在11例术后出现髋臼缺损的病例中，8例在最终随访时完全重塑，3例部分重塑。3个翻修植入物移位超过5毫米，在随访32个月前不得不进行翻修。此外，发生了1例感染性植入物失败。平均随访9年后，93%的研究植入物仍在位，无需进一步翻修，95%未发生无菌性植入物失败。
这项为期12年的临床研究表明，LOR杯为失败的髋臼假体翻修提供了一个成功的概念，同时也促进了骨缺损的生物学重建。与其他随访时间相似的方法相比，我们的长期结果证明该手术的翻修率和无菌性植入物失败率非常低。
