Orthopaedics Department, Hospital Universitario La Paz-Idi Paz, Madrid, Spain.
Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN, Madrid, Spain.
Bone Joint J. 2021 Mar;103-B(3):492-499. doi: 10.1302/0301-620X.103B3.BJJ-2020-1228.R1.
Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed.
In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis.
Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008).
Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: 2021;103-B(3):492-499.
在全髋关节置换术中使用打压植骨（IBG）修复髋臼骨缺损，可促进未来重建失败后的再次翻修。我们假设在 IBG 重复使用后的再次翻修手术中，髋臼骨缺损比前一次翻修手术小。本研究还分析了反复使用 IBG 进行再次翻修的临床和影像学结果。
在使用 IBG 和水泥固定组件的 382 例髋臼翻修病例中，1992 年至 2016 年间，45 髋（45 例）因无菌性松动而失败再次翻修。比较首次翻修和再次翻修手术时根据 Paprosky 分级的髋臼骨缺损情况。对随时间推移的临床和影像学发现进行分析。采用竞争风险分析进行生存分析。
初次翻修术中的术中骨缺损包括 19 例 Paprosky ⅢA型和 29 例 Paprosky ⅢB 型；再次翻修时，7 髋为 Paprosky Ⅱ型，27 髋为 Paprosky ⅢA型，11 髋为 Paprosky ⅢB 型（p=0.020）。术前平均 Harris 髋关节评分（SD，6.4）为 45.4，最终随访时为 80.7（SD，12.7）。共有 12 髋出现髋臼假体放射性迁移，其中 3 髋需要进一步翻修。髋臼假体进一步翻修手术的 9 年累积失败发生率（9 例风险患者）为任何原因的 9.6%（95%可信区间（CI）为 2.9%至 21.0%），无菌性松动的 7.5%（95%CI 为 1.9%至 18.5%）。髋关节高度较高的髋关节发生放射性迁移的风险更高（比值比 1.09，95%CI 为 1.02 至 1.17；p=0.008）。
在髋关节翻修术中使用 IBG 可以获得骨量恢复。该技术在再次翻修手术中也很有用；然而，更好的手术技术，包括更接近髋关节旋转中心的距离，可以降低髋臼假体放射性迁移的风险。需要更长的随访时间来评估潜在的固定恶化情况。
2021；103-B（3）：492-499.
