Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, P.R. China.
Department of Orthopaedics, The People's Hospital of Guang'an City, 1# the Fourth Section of Bin He Road, Guang'an, P.R. China.
BMC Musculoskelet Disord. 2020 Apr 8;21(1):218. doi: 10.1186/s12891-020-03250-0.
Revision total hip arthroplasty (THA) with severe femoral bone defects remains a major challenge. The purpose of this study is to report the minimum 8-year clinical and radiographic results of revision THA with severe femoral bone defects treated with extensively porous-coated stems and cortical strut allografts.
We retrospectively identified 44 patients diagnosed with Paprosky type III and IV femoral bone defects between January 2006 and July 2011. The exclusion criteria were patients not eligible for surgery, revised with extensively porous-coated stems alone, lost to follow-up and deceased. A total of 31 patients treated with extensively porous-coated stems and cortical strut allografts were finally included in this study. The degree of femoral bone defects was categorized as Paprosky type IIIA in 19 patients, type IIIB in 9 patients and type IV in 3 patients. The mean duration of follow-up was 11.0 ± 1.5 (range, 8.1-13.5) years.
The mean Harris Hip Score improved significantly from 43.4 ± 10.5 points to 85.2 ± 6.6 points (P < 0.001). Similarly, WOMAC and SF-12 scores also significantly improved. Twenty-eight stems achieved stable bone ingrowth, two stems showed stable fibrous ingrowth, and one stem was radiologically unstable. Complete union and bridging between cortical strut allografts and host bone was achieved in all 31 patients. The femoral width was augmented with cortical strut allografts after revision surgery (an increase of 10.5 ± 0.5 mm) and showed a slight decrease of 2.5 ± 4.8 mm after the 10-year follow-up. Using re-revision for any reason as an endpoint, the Kaplan-Meier cumulative survival rate of the stem was 96.2% (95% confidence interval, 75.7-99.5%) at 10 years.
Our data demonstrate that the use of extensively porous-coated stems combined with cortical strut allografts in revision THA with Paprosky type III and IV femoral bone defects can provide satisfactory clinical and radiographic outcomes with a minimum follow-up of 8 years.
伴有严重股骨骨缺损的翻修全髋关节置换术（THA）仍然是一个主要挑战。本研究的目的是报告采用广泛多孔涂层柄和皮质骨支柱同种异体骨治疗伴有严重股骨骨缺损的翻修 THA 的至少 8 年临床和影像学结果。
我们回顾性地确定了 2006 年 1 月至 2011 年 7 月期间诊断为 Paprosky Ⅲ型和Ⅳ型股骨骨缺损的 44 例患者。排除标准为不适合手术、仅接受广泛多孔涂层柄翻修、失访和死亡的患者。最终，共有 31 例接受广泛多孔涂层柄和皮质骨支柱同种异体骨治疗的患者被纳入本研究。股骨骨缺损程度在 19 例患者中为 Paprosky ⅢA型，9 例患者中为 Paprosky ⅢB 型，3 例患者中为 Paprosky Ⅳ型。平均随访时间为 11.0±1.5 年（范围 8.1-13.5 年）。
Harris 髋关节评分从 43.4±10.5 分显著提高至 85.2±6.6 分（P<0.001）。同样，WOMAC 和 SF-12 评分也显著改善。28 枚柄实现了稳定的骨长入，2 枚柄表现为稳定的纤维性长入，1 枚柄影像学上不稳定。所有 31 例患者皮质骨支柱同种异体骨与宿主骨之间均实现了完全愈合和桥接。翻修术后使用皮质骨支柱同种异体骨增加了股骨宽度（增加 10.5±0.5mm），10 年随访时股骨宽度略有减少 2.5±4.8mm。以任何原因进行再次翻修为终点，柄的 Kaplan-Meier 累积生存率在 10 年时为 96.2%（95%置信区间，75.7-99.5%）。
我们的数据表明，在伴有 Paprosky Ⅲ型和Ⅳ型股骨骨缺损的翻修 THA 中采用广泛多孔涂层柄联合皮质骨支柱同种异体骨可提供满意的临床和影像学结果，至少随访 8 年。
