Flecher Xavier, Appy Benjamin, Parratte Sébastien, Ollivier Matthieu, Argenson Jean-Noel
Aix-Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France.
Department of Orthopaedics and Traumatology, APHM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France.
Int Orthop. 2017 May;41(5):911-916. doi: 10.1007/s00264-016-3312-2. Epub 2016 Oct 21.
Recent studies have reported short-term favourable results of tantalum-made components in acetabular revisions with bone loss. However, there is a lack of information regarding the mid to long-term results of such components.
The objective of this study was to analyse the outcome and survivorship of acetabular revision hip arthroplasty using tantalum components for loosening associated with bone loss at a minimum of five-year follow-up.
We retrospectively reviewed 51 consecutive patients (51 hips) who had an acetabular revision using porous tantalum components at a minimum follow-up of five years. The mean age was 64 years (range, 31-87). There were 27 males and 24 females, 47 right hips and four left hips. Twenty-five (49 %) included a femoral revision. According to Paprosky's classification 18 hips were classified type 2A, 11 type 2B, ten type 2C, seven type 3A and five type 3B. No bone grafting was performed. Sixteen hips (31.3 %) required the use of additional tantalum-made augments stabilized by screws and cement at the cup-augment interface.
At a mean followup of 6.8 years (range, 5.1-10 years), the Harris hip score improved from 44 pre- operatively (range, 23-72) to 84 post-operatively (range, 33-98). The mean post-operative hip centre position in relation to the teardrop was 29 mm (range, 20-43 mm) horizontally and 21 mm (range, 8-36 mm) vertically. The mean acetabular inclination was 42° (range, 17-60°). Six hips (11.7 %) required a re-operation without component revision (two for chronic instability, one ossification removal, one haematoma, one deep infection and one periprosthetic femoral fracture). One patient required a cup re-revision for septic loosening. No aseptic loosening occurred. At last followup the radiological analysis showed one evolutive osteolysis and one screw breakage. The global survivorship was 92.3 % at 64 months. If only aseptic loosening was defined as the end-point the survivorship was 100 % at 64 months.
When facing an acetabular revision with severe bone loss, tantalum-made components can provide a stable fixation. This study at a minimum five-year follow-up compares favourably with other reconstruction techniques, but longer follow-up is still required.
近期研究报道了钽制部件在伴有骨丢失的髋臼翻修术中的短期良好效果。然而，关于此类部件的中长期结果的信息却很匮乏。
本研究的目的是分析使用钽制部件进行髋臼翻修髋关节置换术治疗与骨丢失相关的松动的结果及生存率，随访时间至少为五年。
我们回顾性分析了连续51例患者（51髋），这些患者接受了多孔钽制部件的髋臼翻修术，随访时间至少为五年。平均年龄为64岁（范围31 - 87岁）。男性27例，女性24例，右髋47例，左髋4例。25例（49%）包括股骨翻修。根据Paprosky分类，18髋为2A型，11髋为2B型，10髋为2C型，7髋为3A型，5髋为3B型。未进行植骨。16髋（31.3%）在髋臼与增强物界面处需要使用额外的钽制增强物并用螺钉和骨水泥固定。
平均随访6.8年（范围5.1 - 10年），Harris髋关节评分从术前的44分（范围23 - 72分）提高到术后的84分（范围33 - 98分）。术后髋关节中心相对于泪滴的平均位置水平为29毫米（范围20 - 43毫米），垂直为21毫米（范围8 - 36毫米）。平均髋臼倾斜度为42°（范围17 - 60°）。6髋（11.7%）需要再次手术但不进行部件翻修（2例因慢性不稳定，1例因骨化清除，1例因血肿，1例因深部感染，1例因假体周围股骨骨折）。1例患者因感染性松动需要进行髋臼再次翻修。未发生无菌性松动。在最后一次随访时，影像学分析显示1例进行性骨溶解和1例螺钉断裂。64个月时总体生存率为92.3%。如果仅将无菌性松动定义为终点，则64个月时生存率为100%。
面对伴有严重骨丢失的髋臼翻修时，钽制部件可提供稳定的固定。本研究至少五年的随访结果与其他重建技术相比具有优势，但仍需要更长时间的随访。
