Clinica Ortopedica, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
Clinic Ortopedia e Traumatologia 2, Joint Replacement Unit, Ospedale Santa Corona, Viale 25 Aprile, 38, 17027, Pietra Ligure, SV, Italy.
Arch Orthop Trauma Surg. 2020 Mar;140(3):415-424. doi: 10.1007/s00402-020-03334-5. Epub 2020 Jan 20.
The management of acetabular bone loss is a challenging problem in revision total hip arthroplasty (rTHA). The aim of this systematic review is to summarize and critically analyze indications, complications, clinical and radiological outcomes of custom-made acetabular components in rTHA.
A systematic review of English literature was performed on Medline. Retrospective or prospective studies with minimum 2 years of follow-up (FU) were included. The PRISMA 2009 flowchart and checklist were considered to edit the review. Rates of intra- or post-operative complications, aseptic loosening (AL), periprosthetic joint infection (PJI), reoperations and re-revisions rates were extrapolated.
18 articles with a level of evidence of IV were included. Six hundred and thirty-four acetabular custom components (627 patients) with a mean FU of 58.6 ± 29.8 months were analyzed. The studies showed good clinical and functional outcomes. Custom-made acetabular components allowed a stable fixation with 94.0 ± 5.0% survival rate. The estimated rate of re-operations and re-revisions were 19.3 ± 17.3% and 5.2 ± 4.7%, respectively. The incidence of PJI was 4.0 ± 3.9%.
The acetabular custom-made implants represent a reliable solution for pelvic discontinuity and particular cases of bone loss classified as Paprosky Type IIIA-B or type III-IV according to American Academy of Orthopaedic Surgeons system where the feature of the defect cannot be handled with standard implants. This strategy allows to fit the implant to the residual host bone, bypassing the bony deficiency and restoring hip biomechanics. Satisfactory clinical and radiological outcomes at mid-term follow-up are reported in literature.
在翻修全髋关节置换术（rTHA）中，髋臼骨缺损的处理是一个具有挑战性的问题。本系统评价的目的是总结和批判性分析定制髋臼假体在 rTHA 中的适应证、并发症、临床和影像学结果。
对 Medline 进行了英语文献的系统评价。纳入了至少随访 2 年（FU）的回顾性或前瞻性研究。采用 PRISMA 2009 流程图和检查表进行评价。术中或术后并发症、无菌性松动（AL）、假体周围关节感染（PJI）、翻修和再翻修率的发生率被推断出来。
纳入了 18 篇证据水平为 IV 级的文章。共分析了 627 例患者的 634 个髋臼定制假体，平均 FU 为 58.6±29.8 个月。研究结果显示出良好的临床和功能结果。定制髋臼假体可实现稳定固定，存活率为 94.0±5.0%。估计的再手术和再翻修率分别为 19.3±17.3%和 5.2±4.7%，PJI 的发生率为 4.0±3.9%。
髋臼定制假体是骨盆不连续和特定类型骨缺损的可靠解决方案，这些骨缺损根据美国矫形外科医师学会系统可分为 Paprosky Ⅲ A-B 或Ⅲ-IV 型，这些类型的缺损无法用标准假体处理。这种策略可以使假体与残留的宿主骨相适应，绕过骨缺损并恢复髋关节生物力学。文献中报告了中期随访时满意的临床和影像学结果。
