Mayo Clinic, Rochester, Minnesota.
University of Florida, Gainesville, Florida.
J Arthroplasty. 2023 Sep;38(9):1827-1838. doi: 10.1016/j.arth.2023.03.038. Epub 2023 Mar 20.
Allograft prosthetic composites (APCs) have been used to perform revision total hip arthroplasty (THA) for massive femoral bone loss or deformity. Intussusception, or "telescoping", APC techniques have been proposed to enhance the contact area of this interface and provide superior mechanical fixation over conventional methods. The purpose of this study is to present to our knowledge, the largest series of telescoping APC THAs, along with surgical technique details and midterm (average 5-10 years) clinical results.
Between 1994 and 2015, 46 revision THAs performed with proximal femoral telescoping APCs were retrospectively reviewed at a single institution. Overall survival, reoperation-free survival, and construct survival rates were calculated via Kaplan-Meier methods. In addition, radiographic analyses were performed to evaluate for component loosening, union at the APC-host interface, and resorption of the allograft.
At 10 years, the overall patient survival was 58%, reoperation-free survival was 76%, and construct survival was 95%. Reoperation was performed in 20% (n = 9) and only 2 constructs required resection. Radiographic analyses performed at latest follow-up revealed no instances of radiographic femoral stem loosening, an 86% union rate at the APC-host site, 23% with signs of some allograft resorption, and a 54% trochanteric union. The mean postoperative Harris hip score was 71 points (range, 46-100).
Telescoping APCs are technically demanding, but provide reliable mechanical fixation for the reconstructing of large proximal femoral bone deficits in revision THA with excellent construct survivorship, acceptable reoperation rates, and good clinical outcomes.
IV.
同种异体假体复合材料 (APCs) 已被用于进行翻修全髋关节置换术 (THA) 以治疗股骨大骨量损失或畸形。内套叠或“伸缩” APC 技术已被提出，以增强该界面的接触面积，并提供优于传统方法的机械固定。本研究的目的是向我们所知，介绍最大系列的伸缩 APC THA，以及手术技术细节和中期（平均 5-10 年）临床结果。
在 1994 年至 2015 年间，在一家单机构回顾性审查了 46 例采用近端股骨伸缩 APC 进行的翻修 THA。通过 Kaplan-Meier 方法计算总生存率、无再手术生存率和结构生存率。此外，进行放射学分析以评估组件松动、APC-宿主界面的融合以及同种异体移植物的吸收。
在 10 年时，总患者生存率为 58%，无再手术生存率为 76%，结构生存率为 95%。20%（n=9）进行了再手术，只有 2 个构建体需要切除。在最新随访时进行的放射学分析显示没有股骨柄松动的放射学迹象，APC-宿主部位的融合率为 86%，23%有一些同种异体吸收的迹象，54%的转子间融合。术后平均 Harris 髋关节评分 71 分（范围 46-100）。
伸缩 APC 技术要求高，但为翻修 THA 中重建大近端股骨骨缺损提供可靠的机械固定，具有出色的结构生存率、可接受的再手术率和良好的临床结果。
IV 级。
