Evola Francesco Roberto, Costarella Luciano, Evola Giuseppe, Barchitta Martina, Agodi Antonella, Sessa Giuseppe
Francesco Roberto Evola, Luciano Costarella, Giuseppe Evola, Giuseppe Sessa, Department of Surgery, Orthopaedic Clinic, University of Catania, 95100 Catania, Italy.
World J Orthop. 2017 Jul 18;8(7):553-560. doi: 10.5312/wjo.v8.i7.553.
To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.
Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An database was created and statistical analyses were performed with SPSS software (IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's test for independent and paired samples. A value of < 0.05 was considered statistically significant and cumulative survival was calculated by the Kaplan-Meier method.
The mean follow-up was 87.6 ± 25.6 mo (range 3-120 mo). 25 cases (43.1%) were classified as minor defects, and 33 cases (56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1 (range: 29-53) before revision, to a mean of 85.8 ± 6.1 (range: 70-94) at the end of the follow-up (Student's test for paired samples: < 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect (Student's test for independent samples: > 0.05). Radiolucent lines were found in 4 implants (6.9%). Postoperative acetabular gaps were observed in 5 hips (8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95% (for all reasons) and 100% for aseptic loosening of the acetabular component.
The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.
评估髋臼组件和钽增强物在髋关节置换翻修术中的临床及X线结果。
对58例髋臼组件初次失败的髋关节假体使用钽植入物进行翻修，并回顾性分析这些病例的临床记录和X线片。骨缺损评估基于术前CT扫描，并根据Paprosky关于透亮线和假体周围间隙的标准进行分类；通过X线评估植入物松动和骨溶解情况。建立数据库，使用SPSS软件（IBM SPSS Statistics for Windows，版本23.0）进行统计分析。采用独立样本和配对样本的t检验进行统计分析。P值<0.05被认为具有统计学意义，采用Kaplan-Meier法计算累积生存率。
平均随访时间为87.6±25.6个月（范围3 - 120个月）。25例（43.1%）被分类为轻度缺损，33例（56.9%）为重度缺损。术前髋关节Harris评分（HHS）从翻修前的平均40.7±6.1（范围：29 - 53）显著提高到随访结束时的平均85.8±6.1（范围：70 - 94）（配对样本t检验：P<0.001）。仅考虑随访结束时的HHS，重度缺损和轻度缺损患者之间未观察到统计学显著差异（独立样本t检验：P>0.05）。4枚植入物（6.9%）发现有透亮线。5例髋关节（8.6%）观察到术后髋臼间隙。末次随访时X线片未发现植入物松动迹象或假体周围骨溶解区域。仅3枚植入物失败：1例感染，2例不稳定。以失败为终点，10年累积生存率为95%（所有原因），髋臼组件无菌性松动的累积生存率为100%。
在各种髋臼骨缺损的髋关节置换翻修术中，中期使用钽假体组件是安全有效的。
