Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.
Nuffield Orthopedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.
Eur Radiol. 2021 Jun;31(6):4221-4231. doi: 10.1007/s00330-020-07463-8. Epub 2020 Nov 17.
To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening.
In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region.
All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations.
RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery.
• Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants. • Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life. • Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.
评估在局部麻醉下进行放射学经皮假体周围骨水泥成形术（RPPBC）的可行性，并验证其治疗假体无菌性松动的安全性和有效性。
在这项病例系列研究中，2011 年 2 月至 2020 年 1 月期间，共纳入 7 名患者（平均年龄 81 岁，年龄范围为 73 岁至 89 岁，男性 2 名，女性 5 名），这些患者均被确诊为骨科植入物的无菌性松动。1 名患者为单髁膝关节置换术后胫骨组件松动，1 名患者为反式肩关节置换术后肩胛盂组件松动，1 名为股骨伽马钉松动，4 名为后路腰椎椎间融合术后椎弓根螺钉松动。所有患者均接受了临床、生化和影像学评估以确认无菌性松动的诊断。所有患者均在双 CT 和透视引导下接受了 RPPBC 治疗。所有手术均由一位经验丰富的放射科医生在局部麻醉下进行。术前、即刻和 6 个月时采用视觉模拟评分（VAS）评估疼痛程度，并评估功能结局。术后即刻和 6 个月时进行 CT 检查以评估治疗区域。
所有患者在整个手术过程中均能很好地耐受 RPPBC。RPPBC 后，所有患者均未出现局部或全身感染或假体周围骨折。未观察到再次出现植入物松动。6 名患者在 6 个月时疼痛消失。所有患者在经过验证的功能评分评估时均表示功能得到改善。
RPPBC 似乎是一种治疗老年患者骨科植入物无菌性松动的有效且可靠的策略，对于不适合翻修手术的体弱或有症状的无菌性松动患者尤其适用。
放射学经皮假体周围骨水泥成形术为因体弱或不适合翻修手术而出现症状性假体无菌性松动的老年患者提供了即时和长期的疼痛缓解。
放射学经皮假体周围骨水泥成形术可迅速且长期改善临床功能结局，有效减轻疼痛，从而提高整体生活质量。
放射学经皮假体周围骨水泥成形术是一种安全、快速、可靠且耐受性良好的微创治疗方法，可在简单的局部区域麻醉下轻松进行，需要短期住院治疗。
