Department of Orthopaedic Surgery, Chiba Rehabilitation Center, Chiba, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Orthopaedic Surgery, Chiba Rehabilitation Center, Chiba, Japan.
J Arthroplasty. 2017 Nov;32(11):3495-3501. doi: 10.1016/j.arth.2017.06.026. Epub 2017 Jun 20.
Bone deficiency in revision total hip arthroplasty is a surgical challenge. The Murata-Chiba cup supporter (MC support ring) is an acetabular component supporter for a cementless porous-coated cup. The purpose of this study is to examine the clinical and radiographic outcomes of reconstruction of acetabular bone deficiency using iliac autografts supported by an MC support ring in a revision setting with minimum 15-year follow-up.
Fifty-nine consecutive revision total hip arthroplasties (57 patients) using the MC support ring were followed for a minimum of 15 years. Nine hips had American Academy of Orthopaedic Surgeons type II deficiency and 24 had type III defects of the acetabulum. Clinical outcomes were evaluated using the Harris hip score. Radiographic evaluation included assessment for loosening and bone graft incorporation. Kaplan-Meier survival analysis was performed.
At a minimum 15-year follow-up (mean, 17.6 years), 32 patients (33 hips) were alive, 17 patients (18 hips) were deceased, and 8 patients (8 hips) were lost to follow-up. The mean Harris hip score improved from 44.3 to 77.2 at final follow-up. Four hips required reoperation due to deep infection (2 hips) and liner dissociation (2 hips), but no acetabular components were revised for aseptic loosening. Incorporation of the bone graft occurred in all cases. One unrevised patient had radiographic failure. Survivorship at 15 years with re-revision or radiographic failure as the end point was 90.6% (95% confidence interval, 83.0%-98.8%).
The reconstruction of acetabular bone deficiency using autografts supported by an MC support ring provided satisfactory clinical and radiological results at 17.6 years postoperatively.
在翻修全髋关节置换术中，骨缺损是一个手术挑战。Murata-Chiba 杯支撑器（MC 支撑环）是一种用于非骨水泥多孔涂层杯的髋臼部件支撑器。本研究旨在检查使用 MC 支撑环支撑的髂骨自体移植物重建髋臼骨缺损的临床和影像学结果，这些翻修病例的随访时间至少为 15 年。
59 例（57 例患者）连续使用 MC 支撑环进行翻修全髋关节置换术，随访时间至少 15 年。9 髋为美国矫形外科医师学会（AAOS）Ⅱ型缺损，24 髋为髋臼Ⅲ型缺损。临床结果采用 Harris 髋关节评分进行评估。影像学评估包括松动和植骨融合的评估。采用 Kaplan-Meier 生存分析。
在至少 15 年的随访（平均 17.6 年）中，32 例（33 髋）患者存活，17 例（18 髋）患者死亡，8 例（8 髋）患者失访。最终随访时，Harris 髋关节评分从 44.3 分提高到 77.2 分。4 髋因深部感染（2 髋）和衬垫分离（2 髋）需要再次手术，但无髋臼部件因无菌性松动而翻修。所有病例均发生植骨融合。1 例未翻修患者出现影像学失败。以再次翻修或影像学失败为终点，15 年的生存率为 90.6%（95%置信区间，83.0%-98.8%）。
使用 MC 支撑环支撑的自体移植物重建髋臼骨缺损，在术后 17.6 年时提供了满意的临床和影像学结果。
