Bagsby Deren T, Wurtz L Daniel
Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana.
J Arthroplasty. 2017 Apr;32(4):1250-1254. doi: 10.1016/j.arth.2016.11.038. Epub 2016 Nov 27.
Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear.
Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified. All patients had a constrained acetabular liner implanted during their index procedure. Electronic medical records and radiographs were reviewed. A literature review of studies with similar technique was used as a historical control.
Forty-seven patients (69.2%) died 22.7 ± 22.7 months after surgery, at age 62.4 ± 17.2 years. At an average clinical follow-up of 9.9 ± 14.2 months (range 2-50 months), we found no incidents of dislocation. No patients had component failure requiring revision or evidence of loosening on x-ray. Thirteen papers, comprising 185 patients, demonstrated 39 patients (21.1%) with dislocations and 13 patients (7.0%) requiring revision surgery for aseptic loosening.
Modified Harrington technique has demonstrated relative durability when reconstructing metastatic acetabular disease, although dislocation occurs in approximately 20% of patients. This study demonstrates that initial use of a constrained liner can alleviate postoperative dislocations without increasing risk of perioperative complications. Even modest reduction in complications during the limited lifespan of oncologic patients can have dramatic positive effects on quality of life.
髋臼破坏性病变患者的发病风险很高。哈林顿描述了用甲基丙烯酸甲酯加固髋臼病变骨，并辅以金属固定，以进行全髋关节重建。然而，所有发表的使用该技术的研究均报告了脱位情况。我们认为，最初使用限制性衬垫将有助于降低脱位风险，而不会增加假体松动或聚乙烯磨损。
确定了2005年8月至2015年3月期间因转移性癌症接受哈林顿髋关节置换术的68例患者。所有患者在初次手术期间均植入了限制性髋臼衬垫。回顾了电子病历和X光片。对采用类似技术的研究进行文献综述作为历史对照。
47例患者（69.2%）在术后22.7±22.7个月死亡，年龄为62.4±17.2岁。平均临床随访9.9±14.2个月（范围2 - 50个月），我们未发现脱位事件。没有患者出现需要翻修的假体失败情况，X光片上也没有松动迹象。13篇论文，共185例患者，显示39例患者（21.1%）发生脱位，13例患者（7.0%）因无菌性松动需要翻修手术。
改良的哈林顿技术在重建转移性髋臼疾病时已显示出相对的耐用性，尽管约20%的患者会发生脱位。本研究表明，最初使用限制性衬垫可减轻术后脱位，而不会增加围手术期并发症的风险。即使在肿瘤患者有限的生存期内并发症有适度减少，也会对生活质量产生显著的积极影响。
