Gaetano Pini Orthopaedic Institute, Milan, Italy.
Int J Immunopathol Pharmacol. 2011 Jan-Mar;24(1 Suppl 2):133-7. doi: 10.1177/03946320110241S225.
Current evidences in revision hip arthroplasty suggest to treat severe acetabular bone loss with dedicated implants, such as anti-protrusio cages, stemmed cups, modular systems supplied with iliac flanges and obturatory hook. However recent literature is reporting satisfactory outcomes with simple elliptical Trabecular Metal cups. Purpose of the study was to evaluate mid-term results of such a surgical procedure. All hip revisions performed from 2008 to 2009 with implantation of a TMT multi-hole acetabular cup without augmentations were retrospectively reviewed. The cases with low-degree acetabular bone loss (stage I and II according to GIR classification), with surgical report poorly describing the bone defect, with inadequate pre- and post-operative x-rays were ruled out. Twenty-five cases were identified, but four were lost to follow-up. The twenty-one patients were 71 year-old on average (from 60 to 82), with stage IV bone loss in 6 cases and stage III bone loss in 15 cases. Mean interval from surgery to evaluation was 20.9 months (from 13 to 30). The evaluation included bone-prosthesis contact estimation, component position, survivorship, complications, final Harris Hip Score, presence of periprosthetic radiolucencies. Host bone-prosthesis contact was estimated to be about 35%. Only three implant were subsequently reoperated (for infection, early migration, recurrent dislocation). The HHS among non-reoperated 18 patients was 81.96 on average (from 63.44 to 95.82). Six cases showed thin radiolucencies in one of the three Charnley zones, while three cases showed radiolucencies in two. None of these images was evolutive, thus they were not considered signs of loosening. The mid-term results of this series confirm the hypothesis that a porous tantalum acetabular cup is an effective option to deal with difficult acetabular revisions. Although no extra-acetabular fixation device is available, the very high surface friction guaranteed by the material and the supplemental stability provided by trans-acetabular screws seem to be sufficient to allow satisfactory reimplantation even in severely damaged pelves.
目前，针对髋关节翻修术中严重髋臼骨缺损的治疗，已有研究建议使用专用植入物，如抗前突笼、带柄杯、带有髂嵴翼和闭塞钩的模块化系统。然而，最近的文献报道，使用简单的椭圆形 Trabecular Metal 杯也可获得满意的结果。本研究旨在评估该手术的中期结果。回顾性分析了 2008 年至 2009 年期间，采用 TMT 多孔髋臼杯（未行骨增量）进行髋关节翻修的所有病例。排除髋臼骨缺损程度较低（GIR 分级 I 期和 II 期）、手术报告对骨缺损描述不充分、术前和术后 X 线片不足的病例。共确定了 25 例病例，但其中 4 例失访。21 例患者的平均年龄为 71 岁（60-82 岁），6 例为 IV 期骨缺损，15 例为 III 期骨缺损。从手术到评估的平均时间为 20.9 个月（13-30 个月）。评估内容包括：骨-假体接触估计、假体位置、存活率、并发症、最终 Harris 髋关节评分、假体周围放射透亮区。宿主-假体接触估计约为 35%。仅 3 例植入物随后再次手术（感染、早期迁移、复发性脱位）。18 例未再次手术患者的 HHS 平均为 81.96（63.44-95.82）。6 例在 3 个 Charnley 区中的 1 个区出现了薄的放射透亮区，3 例在 2 个区出现了放射透亮区。这些图像均无进展，因此不被认为是松动的迹象。本系列的中期结果证实了多孔钽髋臼杯是处理困难髋臼翻修的有效选择的假设。尽管没有额外的髋臼固定装置，但该材料提供的非常高的表面摩擦力和经髋臼螺钉提供的附加稳定性似乎足以允许即使在严重受损的骨盆中也能进行满意的再植入。
