Yang Chao, Zhang Lei, Chen Shuo, Zhou Liwu, Zhao Jianning
Clinical College of Medical School of Nanjing University, Nanjing Jiangsu, 210000, P.R.China;Department of Orthopedics, Nanjing General Hospital of Nanjing Military Command, Nanjing Jiangsu, 210002, P.R.China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):139-143. doi: 10.7507/1002-1892.201607089.
To investigate the change of the femoral offset and hip center of rotation (COR) after using Jumbo cups in total hip arthroplasty (THA) revision.
The clinical data of 23 patients who underwent THA revision using Jumbo cups between January 2010 and May 2015 were retrospectively analyzed. Morselized bone graft was performed on 8 cases, morselized bone graft combined with structural bone graft on 10 cases. There were 10 males and 13 females, aged 65.4 years on average (range, 51-77 years). The disease duration was 1-24 years (mean, 8.57 years). The reasons for revision included aseptic loosening in 21 cases and periprosthetic infection in 2 cases. The Harris hip score and visual analogue scale (VAS) were 43.04±5.05 and 5.70±0.97 before operation respectively. According to the Paprosky acetabular defect classification, there were 5 cases of type I, 5 cases of type II A, 3 cases of type II B, 6 cases of type II C, and 4 cases of type III A. The X-ray films showed that the femoral offset was (40.65±4.09) mm for normal side and was (44.04±5.08) mm for affected side at preoperation, showing significant difference ( =4.098, =0.000). Ten patients underwent femoral offset reconstruction (43.48%) but 13 patients did not (56.52%) before operation. The COR was reconstructed in 10 cases (43.48%); COR elevation was observed in 11 cases (47.83%), and COR decline in 2 cases (8.69%) before operation.
Primary healing of incision was obtained in all patients, with no complication of infection, vascular injury, deep vein thrombosis, dislocation of the joint, or fracture around prosthesis. All the patients were followed up 12-76 months (mean, 22.48 months). The Harris hip score and VAS were 82.09±4.53 and 0.74±0.62 at 1 year after operation respectively, showing significant differences when compared with preoperative scores ( =37.831, =0.000; =22.318, =0.000). The X-ray films showed that the femoral offset was (43.87±3.57) mm for affected side at 1 year after operation, showing no significant difference when compared with preoperative one ( =0.250, =0.805), but significant difference was found between affected side and normal side ( =5.591, =0.000). The femoral offset was restored in 16 patients (69.57%) and was not restored in 7 patients (30.43%) after operation. The COR was restored in 15 patients (65.22%) and was not restored in 8 patients (34.78%).
Using Jumbo cups or combined with morselized or structural bone graft is effective in restoring hip COR and femoral offset at the maximum limit in THA revision, with good short-term outcome and improved stability of acetabular prosthesis.
探讨在全髋关节置换术（THA）翻修中使用大臼杯后股骨偏心距和髋关节旋转中心（COR）的变化。
回顾性分析2010年1月至2015年5月期间23例行THA翻修并使用大臼杯的患者的临床资料。8例行颗粒骨移植，10例行颗粒骨移植联合结构性骨移植。男性10例，女性13例，平均年龄65.4岁（范围51 - 77岁）。病程1 - 24年（平均8.57年）。翻修原因包括无菌性松动21例，假体周围感染2例。术前Harris髋关节评分和视觉模拟评分（VAS）分别为43.04±5.05和5.70±0.97。根据Paprosky髋臼缺损分类，Ⅰ型5例，ⅡA 型5例，ⅡB型3例，ⅡC型6例，ⅢA型4例。X线片显示术前正常侧股骨偏心距为（40.65±4.09）mm，患侧为（44.04±5.08）mm，差异有统计学意义（t = 4.098，P = 0.000）。术前10例患者（43.48%）进行了股骨偏心距重建，13例患者（56.52%）未进行重建。术前10例（43.48%）进行了COR重建；11例（47.83%）观察到COR升高，2例（8.69%）观察到COR下降。
所有患者切口均一期愈合，无感染、血管损伤、深静脉血栓形成、关节脱位或假体周围骨折等并发症。所有患者均获随访12 - 76个月（平均22.48个月）。术后1年Harris髋关节评分和VAS分别为82.09±4.53和0.74±0.62，与术前评分比较差异有统计学意义（t = 37.831，P = 0.000；t = 22.318，P = 0.000）。X线片显示术后1年患侧股骨偏心距为（43.87±3.57）mm，与术前比较差异无统计学意义（t = 0.250，P = 0.805），但患侧与正常侧比较差异有统计学意义（t = 5.591，P = 0.000）。术后16例患者（69.57%）股骨偏心距恢复，7例患者（30.43%）未恢复。15例患者（65.22%）COR恢复，8例患者（34.78%）未恢复。
在THA翻修中使用大臼杯或联合颗粒骨或结构性骨移植能最大程度有效恢复髋关节COR和股骨偏心距，短期效果良好，髋臼假体稳定性提高。
