Busanelli L, Castagnini F, Bordini B, Stea S, Calderoni P P, Toni A
Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
Musculoskelet Surg. 2019 Aug;103(2):173-179. doi: 10.1007/s12306-018-0573-5. Epub 2018 Oct 16.
Reconstructions in case of acetabular bone loss in hip revision arthroplasty are challenging. A few techniques have been proposed, with inconstant outcomes. Biological reconstructions using bone allografts may address the acetabular bone loss and restore the hip anatomy. Aim of this work was the description of the surgical technique and the evaluation of the outcomes using a regional arthroplasty register.
Minor or massive bone allografting was performed in hip revision arthroplasties in a tertiary center. Bulk allografts were used in severe acetabular bone losses. Fresh-frozen femoral heads were impacted in the bone cavity and porous cups were implanted; multihole sockets were used when necessary. In DeLee A zone, no grafts were used in order to reduce overstress graft resorption. The results were evaluated using a regional arthroplasty register, and a comparison with revisions without bone grafts was performed investigating re-revision rates and reasons for further revisions.
At 10 years, acetabular revisions with bone allografts achieved a similar survival rate than revisions without bone grafts. The re-revisions occurred more frequently in revisions without bone allografts (10.8 vs. 9.7%). In the allograft cohort, septic loosening was lower (0.3 vs. 2.6%), whereas a higher rate of aseptic cup loosening was experienced (2.7 vs. 1.4%).
Bone allografts may provide a good restoration of the acetabular bone stock and the hip biomechanics. Septic loosening does not seems a major concern, whereas a higher rate of aseptic cup loosening should be expected when bone grafts are used.
髋关节翻修术中髋臼骨缺损的重建具有挑战性。已经提出了一些技术，但效果不一。使用同种异体骨的生物学重建可能解决髋臼骨缺损并恢复髋关节解剖结构。本研究的目的是描述手术技术并使用区域关节置换登记系统评估结果。
在一家三级中心对髋关节翻修术患者进行少量或大量同种异体骨移植。严重髋臼骨缺损时使用大块同种异体骨。将新鲜冷冻的股骨头打入骨腔并植入多孔髋臼杯；必要时使用多孔髋臼杯。在DeLee A区，不使用骨移植以减少移植骨过度应力吸收。使用区域关节置换登记系统评估结果，并与未进行骨移植的翻修术进行比较，调查再次翻修率和进一步翻修的原因。
10年时，使用同种异体骨进行髋臼翻修术的生存率与未使用骨移植的翻修术相似。未使用骨移植的翻修术再次翻修的频率更高（10.8%对9.7%）。在同种异体骨移植组中，感染性松动较低（0.3%对2.6%），而无菌性髋臼杯松动的发生率较高（2.7%对1.4%）。
同种异体骨移植可能对髋臼骨量和髋关节生物力学提供良好的恢复。感染性松动似乎不是主要问题，而使用骨移植时应预期无菌性髋臼杯松动的发生率较高。
