Takigami Iori, Otsuka Hiromi, Yamamoto Koji, Iwase Toshiki, Fujita Hiroshi, Matsuda Shuichi, Akiyama Haruhiko
Department of Orthopaedic Surgery, Gifu University, 1-1 Yanagido, Gifu, 5-1-1194, Japan.
J Orthop Sci. 2015 Mar;20(2):331-9. doi: 10.1007/s00776-014-0675-3. Epub 2014 Nov 20.
Impaction bone grafting (IBG) using a circumferential metal mesh is one of the options that allow restoration of the femoral bone stock and stability of the implant in revision hip arthroplasty. Here we examine the clinical and radiographic outcome of this procedure using a cemented stem, including experimental analysis of the initial stability of mesh-grafted bone-cemented stem complexes.
We retrospectively reviewed six hips (six patients) that had undergone femoral revisions with a circumferential metal mesh, impacted bone allografts, and a cemented stem. The mean follow-up period was 3.9 years (range 2.4-4.8 years). Hip joint function was evaluated using the Japanese Orthopaedic Association hip score, and radiographic changes were determined from radiographs. The initial resistance of mesh-grafted bone-cemented stem complexes to axial and rotational force was measured in a composite bone model with various segmental losses of the proximal femur.
The hip score improved from 50 (range 10-84) preoperatively to a mean of 74 (range 67-88) at the final follow-up. The overall implant survival rate was 100 % at five years when radiological loosening or revision for any reason was used as the endpoint. No stem subsided more than 3 mm vertically within one year after implantation. Computed tomography showed reconstitution of the femoral canal in a metal mesh. In mechanical analyses, there was no relationship between IBG reconstruction rates under axial compression and stem subsidence or failure load. In contrast, under rotational load, the rotation angles of the stem to the stainless steel mesh were strongly affected by the IBG reconstruction rate.
The short-term results show good outcomes for reconstruction of proximal bone loss with IBG and a circumferential mesh. The procedure should be applied in cases where the circumferential proximal bone loss is less than half the length of the implanted stem.
使用环形金属网进行嵌压植骨（IBG）是在翻修髋关节置换术中恢复股骨骨量和植入物稳定性的选择之一。在此，我们研究了使用骨水泥型柄进行该手术的临床和影像学结果，包括对网孔植骨 - 骨水泥柄复合体初始稳定性的实验分析。
我们回顾性分析了6例（6名患者）接受股骨翻修手术的病例，手术采用环形金属网、异体骨嵌压植骨和骨水泥型柄。平均随访时间为3.9年（范围2.4 - 4.8年）。使用日本骨科协会髋关节评分评估髋关节功能，并通过X线片确定影像学变化。在股骨近端不同节段缺损的复合骨模型中，测量网孔植骨 - 骨水泥柄复合体对轴向和旋转力的初始阻力。
髋关节评分从术前的50分（范围10 - 84分）提高到最终随访时的平均74分（范围67 - 88分）。以任何原因导致的放射学松动或翻修为终点，五年时植入物总体生存率为100%。植入后一年内，柄垂直下沉不超过3毫米。计算机断层扫描显示金属网内股骨管重建。在力学分析中，轴向压缩下的IBG重建率与柄下沉或破坏载荷之间无相关性。相比之下，在旋转载荷下，柄相对于不锈钢网的旋转角度受IBG重建率的强烈影响。
短期结果表明，使用IBG和环形网重建近端骨缺损效果良好。该手术应应用于环形近端骨缺损小于植入柄长度一半的病例。
