Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France.
Service d'orthopédie-traumatologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France; Université Clermont-Auvergne, SIGMA Clermont, institut de chimie de Clermont-Ferrand, BP 10448, 63000 Clermont-Ferrand, France; CNRS, UMR 6296, ICCF, 63178 Aubière, France.
Orthop Traumatol Surg Res. 2017 Jun;103(4):543-548. doi: 10.1016/j.otsr.2017.03.008. Epub 2017 Mar 30.
Acetabular cup loosening is among the main reasons for revision total hip arthroplasty (THA). The implantation of a cryopreserved morsellised bone allograft is a reference method for filling bone defects. However, the outcomes of bone grafts treated with viral inactivation and secured into the host bone (notably using a reinforcement device) are unclear. We therefore retrospectively reviewed cases of acetabular revision with morsellised bone allograft implanted into a reinforcement ring for acetabular revision to assess: (1) clinical survival of the acetabular implant (time to new revision with acetabular component removal), (2) radiological implant survival, (3) and bone graft osseointegration evaluated using Oswestry's criteria.
Virus-inactivated bone allografts provide similar outcomes to cryopreserved allografts.
From 2004 to 2009, 95 patients underwent acetabular revision. There were 60 (63%) females and 35 (37%) males with a mean age of 71.7 years (range: 44.2-90 years). Over 90% of patients had bone defects type 2 or higher in the AAOS classification. Each patient was evaluated after at least 5 years, by an examiner who had not been involved in the revision and who determined the Postel-Merle d'Aubigné (PMA) score and patient satisfaction. We assessed the clinical survival of the acetabular implant (time to new revision with acetabular implant removal), radiological implant survival (migration>5mm, active radiolucent line, failure of graft osseointegration, or reinforcement ring failure), and allograft osteointegration evaluated using Oswestry's criteria.
After a mean follow-up of 7years (range: 5.2-10years), 7 (7.4%) patients had been lost to follow-up and 3 (3.4%) had required surgical revision, after 3 to 73 months (for aseptic loosening in 2 cases and infection in 1 case). The estimated 10-year survival rate was 96.2% (95% confidence interval [95%CI]: 88.2-98.7). The mean PMA score at last follow-up had increased significantly, by 2.8 points (p<0.05), to 13.8 (95%CI: 78.4-88.1). Of the 88 re-evaluated patients, 78 (89%) were satisfied or very satisfied. The overall radiological survival rate was 84.5% (95%CI: 78.4-88.1) after a mean of 5.9 years (range: 0.5-10). Allograft osseointegration was satisfactory (Oswestry score≥2) in 95.8% of patients.
In our population, allografts previously subjected to virus inactivation and implanted into a reinforcement ring produced outcomes similar to those reported previously with cryopreserved allografts.
IV, retrospective case-series study.
髋臼杯松动是全髋关节翻修术（THA）的主要原因之一。冷冻保存的颗粒状骨移植物的植入是填充骨缺损的参考方法。然而，经过病毒灭活处理并固定到宿主骨中的骨移植物（特别是使用增强装置）的结果尚不清楚。因此，我们回顾性分析了使用颗粒状骨移植物植入髋臼增强环进行髋臼翻修的病例，以评估：（1）髋臼植入物的临床存活率（需要新的髋臼组件移除的翻修时间），（2）放射学植入物存活率，（3）使用 Oswestry 标准评估骨移植物的骨整合情况。
病毒灭活的同种异体移植物提供与冷冻保存同种异体移植物相似的结果。
2004 年至 2009 年，95 例患者接受了髋臼翻修。其中 60 例（63%）为女性，35 例（37%）为男性，平均年龄 71.7 岁（范围：44.2-90 岁）。超过 90%的患者在 AAOS 分类中存在 2 型或更高类型的骨缺损。每个患者至少随访 5 年，由未参与翻修的检查者进行评估，并确定 Postel-Merle d'Aubigné（PMA）评分和患者满意度。我们评估了髋臼植入物的临床存活率（需要新的髋臼植入物移除的翻修时间）、放射学植入物存活率（>5mm 的迁移、活跃的透明线、移植物骨整合失败或增强环失败），以及使用 Oswestry 标准评估同种异体骨整合情况。
平均随访 7 年（范围：5.2-10 年）后，7 例（7.4%）患者失访，3 例（3.4%）需要手术翻修，时间为 3 至 73 个月（2 例为无菌性松动，1 例为感染）。10 年的估计生存率为 96.2%（95%置信区间[95%CI]：88.2-98.7）。末次随访时，PMA 评分平均显著增加 2.8 分（p<0.05），达到 13.8（95%CI：78.4-88.1）。在 88 例重新评估的患者中，78 例（89%）满意或非常满意。平均随访 5.9 年后（范围：0.5-10 年），总体放射学存活率为 84.5%（95%CI：78.4-88.1）。95.8%的患者同种异体骨整合情况良好（Oswestry 评分≥2）。
在我们的人群中，经过病毒灭活处理并植入增强环的同种异体移植物的结果与先前报道的冷冻保存同种异体移植物相似。
IV，回顾性病例系列研究。
