Horberg John V, Bailey J Ross, Kay Kathleen, Allan D Gordon
Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
Orthopaedic Center of Illinois, Springfield, IL, USA.
Arthroplast Today. 2021 May 31;9:78-82. doi: 10.1016/j.artd.2021.04.014. eCollection 2021 Jun.
There is no consensus on how to best address acetabular insufficiency. Several described techniques have a high rate of loosening and most rely on fixation to intact innominate bones. They also require extensive exposure and expensive implants. We present a novel technique for acetabular insufficiency management including discontinuity and a series with mean 6.5-year follow-up.
After exposure, a femoral neck osteotomy is made, or the femoral component is removed. Bone graft is reverse reamed into the defect, and a porous coated acetabular shell is implanted with screws for supplemental fixation. In 3-6 months, after defect healing, the femoral component is implanted. All staged total hip arthroplasties for pelvic discontinuity from 2010 to 2015 by a single provider with minimum 5-year follow-up were identified. Implant survivorship, Merle d'Aubinge, and visual analog scale scores as well as complications were recorded.
Nine patients were identified with mean 80.8-month follow-up (62-129). Merle D'Aubinge scores improved from 5.6 (4-8) to 15.3 (14-18), and Visual analog scale scores improved from 7.2 (6-9) to 0.8 (0-2). All implants were retained, and all patients were ambulatory at the terminal follow-up. There were 2 greater trochanter fractures, one calcar fracture managed with cerclage, and one patient developed heterotopic ossification.
Staged total hip arthroplasty can be used to address pelvic discontinuity with excellent short- to mid-term outcomes. This technique allows for a more limited exposure and the use of primary hip implants. Fixation is by ingrowth and does not rely on intact pelvic architecture.
对于如何最佳处理髋臼缺损尚无共识。几种已描述的技术松动率高，且大多数依赖于固定至完整的无名骨。它们还需要广泛的显露和昂贵的植入物。我们提出一种处理髋臼缺损的新技术，包括髋臼连续性中断的情况，并报告了一组平均随访6.5年的病例系列。
显露后，行股骨颈截骨术或取出股骨假体。将骨移植材料反向扩髓至缺损处，植入带多孔涂层的髋臼杯并用螺钉辅助固定。3至6个月后，缺损愈合，植入股骨假体。确定了2010年至2015年间由单一术者进行的所有分期全髋关节置换术治疗骨盆连续性中断且随访至少5年的病例。记录植入物生存率、Merle d'Aubigné评分、视觉模拟量表评分以及并发症情况。
共确定9例患者，平均随访80.8个月（62 - 129个月）。Merle d'Aubigné评分从5.6（4 - 8）提高到15.3（14 - 18），视觉模拟量表评分从7.2（6 - 9）提高到0.8（0 - 2）。所有植入物均得以保留，所有患者在末次随访时均能行走。发生2例大转子骨折，1例股骨距骨折采用环扎术处理，1例患者出现异位骨化。
分期全髋关节置换术可用于处理骨盆连续性中断，具有优异的短期至中期疗效。该技术允许更有限的显露并可使用初次髋关节植入物。固定靠骨长入，不依赖完整的骨盆结构。
