Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
Orthop Surg. 2022 Oct;14(10):2519-2526. doi: 10.1111/os.13471. Epub 2022 Aug 26.
Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium-term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population.
This was a single-center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze-dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior-posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow-up. Independent sample ANOVA test and Pearson chi-square tests are used for statistical analysis.
There were 61 hips in 57 patients. The average follow-up time was 35.59 months (5-77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32-58) preoperatively to 86.98 (range: 78-93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow-up. Although one cup migrated, no revision, re-revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow-up.
IBG with low-dose irradiated freeze-dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.
在初次全髋关节置换术（THA）和翻修 THA 中，髋臼缺损的重建极具挑战性。打压植骨（IBG）可恢复髋臼骨量并在解剖学上重建髋臼。我们的研究旨在报告 IBG 在中国人行骨水泥型 THA 中重建髋臼的短期和中期临床及影像学结果。
这是一项单中心回顾性研究，纳入 2013 年 5 月至 2019 年 7 月间的 57 例患者。由一位资深外科医生采用低剂量辐照冻干同种异体骨联合或不联合自体骨，对髋臼缺损患者行 IBG 治疗，再行骨水泥型 THA。在术前、术后 1 周、3 个月、12 个月和每年进行 Harris 髋关节评分（HHS）、标准骨盆前后位片和髋关节侧位片检查。采用 Oswestry 标准评估移植物骨整合情况，并在末次随访时记录并发症。采用独立样本 ANOVA 检验和 Pearson 卡方检验进行统计学分析。
共纳入 57 例患者的 61 髋。平均随访时间为 35.59 个月（5-77 个月）。根据 AAOS 分类，共有 18 髋为节段性骨缺损（Ⅰ型），21 髋和 22 髋分别为空洞性骨缺损（Ⅱ型）和混合性骨缺损（Ⅲ型）。术前 HHS 平均为 44.49（范围：32-58），术后为 86.98（范围：78-93）。所有患者的移植物骨整合均令人满意（Oswestry 评分≥2）。57 例患者（61 髋）在随访期间均未发生脱位。虽然有 1 例髋臼杯发生迁移，但在末次随访时未发现翻修、再翻修、影像学松动、移植物骨溶解或术后并发症。
采用低剂量辐照冻干同种异体骨行髋臼骨缺损重建的 IBG 是一种可靠的 THA 髋臼骨缺损修复技术。
