Service de chirurgie orthopédique et de traumatologie, hôpital Cochin, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
Service de chirurgie orthopédique et de traumatologie, hôpital Cochin, Assistance publique-hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
Orthop Traumatol Surg Res. 2020 May;106(3):589-596. doi: 10.1016/j.otsr.2020.01.012. Epub 2020 Apr 4.
Certain cases of repeated acetabular loosening with severe bone loss are hardly amenable to reconstruction using a Kerboull-type plate with allograft. This limitation is more likely when the severe bone loss occurs in older adults with significant comorbidities that may require a faster procedure. In these indications, a stemmed acetabular cup may be an alternative, although the outcomes have not been well defined, especially for a version where the peg is coated with porous material and additional screws can be added. This led us to conduct a retrospective study to determine: (1) whether a stemmed cup anchored in the iliac isthmus is a viable alternative in these situations, (2) the complication rate and (3) the revision rate for any reason.
A stemmed cup anchored in the iliac isthmus is a viable alternative in cases of repeated revision with severe acetabular bone loss.
We performed a retrospective single-center study. Sixteen Integra™ cups were implanted in 14 patients (mean age 72.8±10.4 years, minimum-maximum: 58-95) who had aseptic acetabular loosening combined with severe acetabular bone loss graded as Paprosky IIIA in 7 hips and IIIB in 9 hips. The patients had undergone a mean of 2.7±1.8 (minimum-maximum: 1-6) procedures (i.e. primary and/or revision arthroplasty) before this cup was implanted. The cup's survivorship at the time of review and the complication rate were determined.
At a mean follow-up of 48.8±23.4 months (minimum-maximum: 7-85), two patients had died and two were lost to follow-up. Six hips experienced one or more complications (37.5%): three infections (18.8%), two mechanical failures (12.5%) and one dislocation (6.7%). The cup had to be removed in three patients (18.8%). These complications required reoperation, thus the cumulative incidence of revision for any reason at 5 years was 31% (95% CI: 11-55%).
Despite the high complication and revision rates, we believe the stemmed acetabular cup is a viable alternative in salvage reconstruction procedures.
IV, Retrospective case study.
对于某些髋臼反复松动且伴有严重骨质丢失的病例，使用同种异体骨Kerboull 型板进行重建效果并不理想。对于患有严重骨质丢失的老年患者，如果存在需要更快手术的合并症，这种局限性更为明显。在这些情况下，带柄髋臼杯可能是一种替代方法，尽管其结果尚未得到很好的定义，特别是对于一种钉头带有多孔材料且可添加额外螺钉的版本。这促使我们进行了一项回顾性研究，以确定：(1) 在这些情况下，用髂骨峡部固定的带柄髋臼杯是否是一种可行的替代方法；(2) 并发症发生率；以及 (3) 任何原因的翻修率。
在髋臼反复松动且伴有严重骨质丢失的情况下，用髂骨峡部固定的带柄髋臼杯是一种可行的替代方法。
我们进行了一项回顾性单中心研究。14 名患者（平均年龄 72.8±10.4 岁，最小-最大：58-95）共植入 16 个 Integra™ 杯，这些患者均为无菌性髋臼松动合并严重髋臼骨质丢失，其中 7 髋为 Paprosky IIIA 级，9 髋为 IIIB 级。在植入该杯之前，患者平均经历了 2.7±1.8（最小-最大：1-6）次手术（即初次和/或翻修关节成形术）。在复查时，确定了杯的存活率和并发症发生率。
在平均 48.8±23.4 个月（最小-最大：7-85）的随访中，2 名患者死亡，2 名患者失访。6 髋发生 1 次或多次并发症（37.5%）：3 例感染（18.8%），2 例机械故障（12.5%），1 例脱位（6.7%）。有 3 名患者（18.8%）需要取出髋臼杯。这些并发症需要再次手术，因此，5 年时任何原因的翻修累积发生率为 31%（95%CI：11-55%）。
尽管并发症和翻修率较高，但我们认为带柄髋臼杯是挽救性重建手术的一种可行替代方法。
IV，回顾性病例研究。
