Nodzo Scott R, Boyle Keely K, Pavlesen Sonja, Rachala Sridhar
Department of Orthopaedics, University at Buffalo Department of Orthopaedics, 462 Grider Street, Buffalo, NY, 14215, USA.
University at Buffalo Department of Orthopaedics, 100 High Street, Buffalo, NY, 14203, USA.
Int Orthop. 2018 Apr;42(4):783-789. doi: 10.1007/s00264-017-3671-3. Epub 2017 Nov 3.
The restoration of acetabular bone stock during revision hip arthroplasty remains a challenge. There have been no clinical series reporting the efficacy of bone morphogenic protein-2 (rhBMP-2) in the revision hip setting.
We retrospectively reviewed the radiographs and records of 15 patients who received rhBMP-2 mixed with allograft bone chips (+BMP), and 14 who received allograft bone chips alone (-BMP) for their acetabular defect during revision total hip arthroplasty with a mean two-year follow up. Radiographs were evaluated for acetabular defect size, superior cup migration, and changes in the lateral cup abduction angle. Modified Harris hip scores were used for evaluation of clinical outcomes.
Patients in the +BMP group compared to the -BMP group had significantly larger amounts of cancellous bone chips used (72.1 ± 35.5 cc vs. 38.6 ± 14.1 cc; p = 0.003). Mean rhBMP-2 used per case was 7.4 ± 3.1 mg in the +BMP group. Three patients in the -BMP group had cup migration which was not observed in the +BMP group. Mean Harris hip scores (HHS) improved post-operatively in both groups (40.1 ± 20.9 to 71.9 ± 19, p < .0001). No local adverse reaction was noted in the +BMP group.
rhBMP-2 had modest clinical benefit in the setting of revision THA. Cost of this synthetic biologic versus the added clinical benefit should be carefully considered when being used in the revision hip setting.
髋关节翻修术中髋臼骨量的恢复仍然是一项挑战。目前尚无临床系列报道骨形态发生蛋白-2（rhBMP-2）在髋关节翻修中的疗效。
我们回顾性分析了15例在髋关节翻修术中接受rhBMP-2与同种异体骨屑混合（+BMP组）以及14例仅接受同种异体骨屑（-BMP组）治疗髋臼缺损患者的X线片和记录，平均随访两年。评估X线片上髋臼缺损大小、髋臼杯上移情况以及髋臼杯外侧外展角的变化。采用改良Harris髋关节评分评估临床疗效。
与-BMP组相比，+BMP组使用的松质骨屑量显著更多（72.1±35.5立方厘米对38.6±14.1立方厘米；p = 0.003）。+BMP组每例平均使用rhBMP-2 7.4±3.1毫克。-BMP组有3例出现髋臼杯移位，而+BMP组未观察到。两组术后Harris髋关节评分（HHS）均有改善（40.1±20.9至71.9±19，p <.0001）。+BMP组未观察到局部不良反应。
rhBMP-2在髋关节翻修术中具有一定的临床益处。在髋关节翻修中使用这种合成生物制剂时，应仔细考虑其成本与增加的临床益处。
