Murcia-Asensio Antonio, Ferrero-Manzanal Francisco, Sanz-Ruiz Pablo, Cañada-Oya Hermenegildo, Lax-Pérez Raquel, Goetze Christian
Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003 Murcia, Spain.
Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain.
Case Rep Orthop. 2022 Jun 6;2022:4062172. doi: 10.1155/2022/4062172. eCollection 2022.
Reconstruction of acetabular bone defects by the combination of trabecular metal augments and porous cups can be complex when extensive bone loss and poor-quality bone exists. The onset of porous cups with an interlocking mechanism may simplify surgical technique due to its superior initial mechanical stability. We endorse the possibility for a change in the classical order of setting of the augments and the cup.
We present a technical modification and a series of cases of three patients with Paprosky IIB and IIIA acetabular defects operated with a combination of porous metal augments and a porous cup. In all the three patients, the setting of the cup was done first and secured with locked screws, and then the augments were set in place as a wedge and fixed with screws in a standard fashion.
The postoperative X-ray showed good position of implants with restoration of the center of rotation, and the patients had good recovery. Radiological evaluation in the midterm follow-up did not show mobilization of implants. . The use of metal porous augments is widely used for severe acetabular defects, being a versatile system to adapt to the different size defects. Nevertheless, its use may be technically demanding and time consuming. It is not infrequent that the setting of the augments conditions the final position of the cup with a possible interference with initial stability and eventually bone ingrowth of the cup. The interlocking mechanism offers an additional biomechanical stability and thus may allow us to place the cup first in the desired position with a less demanding technique.
With the use of locked-screw porous metal cups, the order of setting of implants may be changed in order to obtain a better restoration of the center of rotation and increased host-bone implant contact with a simplified surgical technique.
当存在广泛骨质流失和骨质质量较差的情况时，采用小梁金属增强物和多孔杯联合修复髋臼骨缺损可能会很复杂。具有互锁机制的多孔杯因其卓越的初始机械稳定性，可能会简化手术技术。我们认可改变增强物和髋臼杯传统置入顺序的可能性。
我们介绍了一种技术改良方法以及三例采用多孔金属增强物和多孔杯联合手术治疗的帕普罗夫斯基IIB型和IIIA型髋臼缺损患者的病例。在所有这三名患者中，先置入髋臼杯并用锁定螺钉固定，然后将增强物作为楔块置入并以标准方式用螺钉固定。
术后X线显示植入物位置良好，旋转中心得以恢复，患者恢复良好。中期随访的影像学评估未显示植入物松动。金属多孔增强物广泛用于严重髋臼缺损，是一种能适应不同大小缺损的通用系统。然而，其使用在技术上可能要求较高且耗时。增强物的置入常常会影响髋臼杯的最终位置，可能会干扰其初始稳定性并最终影响髋臼杯的骨长入。互锁机制提供了额外的生物力学稳定性，因此可能使我们能够以要求较低的技术先将髋臼杯置于理想位置。
通过使用带锁定螺钉的多孔金属髋臼杯，可以改变植入物的置入顺序，以通过简化的手术技术更好地恢复旋转中心并增加宿主骨与植入物的接触。
