Vogelpoel Els E, Been Jurjen J, de Gast Arthur A
Department of Orthopedic Surgery, Vrije Universiteit Medical Center, de Boelelaan, 1117, Room 3 F043, 1081 HV Amsterdam, Netherlands.
Cases J. 2009 Mar 25;2:6532. doi: 10.1186/1757-1626-0002-0000006532.
In case of severe post-tuberculosis osteoarthritis of the hip, arthrodesis, excision arthroplasty, or total hip arthroplasty may be considered. The latter can be challenging, because destruction of the joint, and most importantly the acetabulum, is frequently seen. To fill up acetabular bone stock loss during total hip arthroplasty, there is the possibility to use bone auto-grafts and allografts. Complications are graft rejection, mechanical failure of implants and gradual migration of the cup into the graft. Other options for creating a stable acetabular component in total hip replacement are screw fixation of the acetabular component or using a stemmed acetabular component. An alternative is the use of an anti-protrusion cage, for which the risk of loosening however is known. In young patients especially, such solution are not always appealing. Therefore, we created an intended ankylosis of the hip joint to fill up the acetabular bone loss with the patients own femoral head. To our knowledge this treatment strategy has not been described before.
We present a 33-year-old Caucasian woman with an acetabular bone defect caused by tuberculous arthritis of the left hip joint. Instead of performing a resection arthroplasty followed by total hip arthroplasty in a second stage, we decided to intentionally ankylose the hip joint in order to fill up the acetabular defect with the patient's own femoral head. Two years after the start of a one year course of tuberculostatic chemotherapy, we took down the ankylosed hip and placed an uncemented total hip prosthesis. The technical and functional outcome of this procedure appeared to be very favourable, the acetabular defect was filled up and the bone remodeled completely.
In order to resolve the problem of acetabular osseous defects in tuberculous arthritis of the hip, intended spontaneous fusion of the femoral head with the acetabular can be a favorable treatment strategy. Subsequently this situation was used as a solid base for the acetabular component of the total hip prosthesis. It resulted in a optimal acetabular bone stock during acetabular component implantation with a very good technical and clinical outcome at 40-months follow up It is understood that this method may not be applicable to all resembling patients. However, this solution may be considered worthwhile in individual cases.
对于严重的结核后髋关节骨关节炎，可考虑采用关节融合术、切除关节成形术或全髋关节置换术。全髋关节置换术颇具挑战性，因为常可见关节破坏，最重要的是髋臼破坏。为在全髋关节置换术中填补髋臼骨量丢失，可使用自体骨移植和异体骨移植。并发症包括移植排斥、植入物机械故障以及髋臼杯逐渐向移植骨内移位。在全髋关节置换术中创建稳定髋臼组件的其他选择包括髋臼组件的螺钉固定或使用带柄髋臼组件。另一种选择是使用防髋臼突出笼，但其存在松动风险。尤其是在年轻患者中，此类解决方案并不总是具有吸引力。因此，我们通过使髋关节有意融合，利用患者自身股骨头来填补髋臼骨质缺损。据我们所知，此前尚未描述过这种治疗策略。
我们报告一名33岁的白种女性，因左髋关节结核性关节炎导致髋臼骨缺损。我们未采用二期切除关节成形术然后行全髋关节置换术，而是决定有意使髋关节融合，以便用患者自身股骨头填补髋臼缺损。在开始为期一年的抗结核化疗两年后，我们拆除融合的髋关节并植入非骨水泥型全髋关节假体。该手术的技术和功能结果似乎非常良好，髋臼缺损得到填补且骨质完全重塑。
为解决髋关节结核性关节炎中髋臼骨缺损问题，使股骨头与髋臼有意自发融合可能是一种良好的治疗策略。随后，这种情况被用作全髋关节假体髋臼组件的坚实基础。在髋臼组件植入时，这导致了最佳的髋臼骨量，在40个月的随访中取得了非常好的技术和临床结果。据了解，这种方法可能不适用于所有类似患者。然而，在个别情况下，这种解决方案可能值得考虑。
