Kim Young-Ho
Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea.
Hip Pelvis. 2017 Sep;29(3):155-158. doi: 10.5371/hp.2017.29.3.155. Epub 2017 Sep 6.
The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.
随着全髋关节置换需求的增加、预期寿命的延长以及个人活动需求的增长，髋臼杯翻修关节成形术的应用正在上升。为使髋臼杯翻修成功，髋臼杯应在髋臼剩余的支持性骨内获得稳定固定。由于患者剩余的髋臼支持性骨量在翻修成功中起着重要作用，因此有必要对髋臼骨缺损程度进行准确分类。在确定髋臼骨丢失的位置和程度时，最常用的是Paprosky分类系统。常见的治疗选择包括：髋臼衬垫置换、高髋关节中心、椭圆形髋臼杯、带增强物的小梁金属杯、双极髋臼杯、大块结构性植骨、骨水泥固定髋臼杯、非骨水泥固定髋臼杯（包括超大号髋臼杯）、髋臼增强装置（髋臼笼）、小梁金属杯笼。最佳治疗选择取决于骨连续性的程度、可用骨量以及在支持性宿主骨上实现稳定固定的可能性。为实现成功的髋臼杯翻修，术前和术中对骨缺损进行准确评估、根据髋臼骨缺损评估正确选择髋臼翻修方法、采用精确植骨技术等获得植入物初始稳定性的适当技术以及植入物的稳定固定都是必不可少的。
