Department of Orthopaedic Surgery and Traumatology, University Hospital Bonn, Bonn, Germany.
Department of Orthopaedic Surgery and Traumatology, University Hospital Mannheim, Mannheim, Germany.
Technol Health Care. 2022;30(3):703-711. doi: 10.3233/THC-202236.
Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery.
The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA.
Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant.
The average follow-up was 41.9 ± 34.8 months (range 1.5-120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure.
Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.
在翻修全髋关节置换术（RTHA）中，无论是髋臼存在严重骨缺损还是骨盆连续性中断，都对骨科医生提出了巨大的挑战。
本研究旨在评估定制髋臼假体在 RTHA 中失败的危险因素。
本研究纳入了 70 例患有严重髋臼骨缺损（Paprosky Ⅲ型）和骨盆连续性中断，需要接受 RTHA 的患者。所有假体均基于骨盆薄层 CT 扫描构建。如果出现假体周围关节感染（PJI）或无菌性松动（AL），需要取出定制髋臼假体，则认为治疗失败。
平均随访时间为 41.9±34.8 个月（范围 1.5-120 个月）。末次随访时，假体的生存率为 75.7%（70 例中有 53 例）。17 例（15 例 PJI，2 例 AL）需要取出假体。RTHA 之前存在 PJI（p=0.025；OR 3.56（95% CI：1.14；11.21））、股骨部件的附加翻修（p=0.003；OR 8.4（95% CI：1.75；40.42））、类风湿性疾病（p=0.039；OR 3.43（95% CI：1.01；11.40））、术前 CRP＞15.2mg/l（p=0.015；AUC：0.7）和术前血红蛋白＜10.05g/dl（p=0.022；AUC：0.69）是与治疗失败相关的统计学显著危险因素。年龄和 BMI 与假体失败无统计学显著相关性。
治疗失败的危险因素包括先前的 PJI、股骨部件的附加翻修、类风湿性疾病、术前 CRP 升高和术前血红蛋白降低。了解这些危险因素将有助于提高未来的治疗标准。
