Felden A, Vaz G, Kreps S, Anract P, Hamadouche M, Biau D J
Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
Pavillon T de l'Hôpital Edouard Herriot, Hospices Civils de Lyon, place d'Arsonval, 69003 Lyon, France.
Bone Joint J. 2015 Feb;97-B(2):177-84. doi: 10.1302/0301-620X.97B2.34545.
Conventional cemented acetabular components are reported to have a high rate of failure when implanted into previously irradiated bone. We recommend the use of a cemented reconstruction with the addition of an acetabular reinforcement cross to improve fixation. We reviewed a cohort of 45 patients (49 hips) who had undergone irradiation of the pelvis and a cemented total hip arthroplasty (THA) with an acetabular reinforcement cross. All hips had received a minimum dose of 30 Gray (Gy) to treat a primary nearby tumour or metastasis. The median dose of radiation was 50 Gy (Q1 to Q3: 45 to 60; mean: 49.57, 32 to 72). The mean follow-up after THA was 51 months (17 to 137). The cumulative probability of revision of the acetabular component for a mechanical reason was 0% (0 to 0%) at 24 months, 2.9% (0.2 to 13.3%) at 60 months and 2.9% (0.2% to 13.3%) at 120 months, respectively. One hip was revised for mechanical failure and three for infection. Cemented acetabular components with a reinforcement cross provide good medium-term fixation after pelvic irradiation. These patients are at a higher risk of developing infection of their THA.
据报道，传统的骨水泥型髋臼假体植入先前接受过放疗的骨中时，失败率很高。我们建议采用骨水泥重建并增加髋臼加强横梁以改善固定效果。我们回顾了一组45例患者（49髋），这些患者接受过骨盆放疗并接受了带有髋臼加强横梁的骨水泥型全髋关节置换术（THA）。所有髋关节均接受了至少30格雷（Gy）的剂量以治疗原发性附近肿瘤或转移瘤。放疗的中位剂量为50 Gy（第一四分位数至第三四分位数：45至60；均值：49.57，32至72）。THA术后的平均随访时间为51个月（17至137个月）。髋臼假体因机械原因翻修的累积概率在24个月时为0%（0至0%），60个月时为2.9%（0.2至13.3%），120个月时为2.9%（0.2%至13.3%）。有1髋因机械故障翻修，3髋因感染翻修。带有加强横梁的骨水泥型髋臼假体在骨盆放疗后可提供良好的中期固定效果。这些患者发生THA感染的风险较高。
