Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Arch Orthop Trauma Surg. 2023 Oct;143(10):6403-6422. doi: 10.1007/s00402-023-04843-9. Epub 2023 Mar 27.
Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available.
Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system.
Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22-95). The average follow-up period was 7.9 years (range 2-22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87-93]. Trabecular metal augments (93% [76-98]) and shells (97% [84-99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons).
Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts.
PROSPERO: CRD42020223093.
多项研究报道，使用同种异体移植物治疗严重髋臼骨缺损的翻修全髋关节置换术（rTHA）可获得良好至优秀的结果。然而，同种异体移植物类型和重建方法的具体信息尚不清楚。
系统检索 Medline 和 Web of Science 中的文献，纳入髋臼骨丢失根据 Paprosky 分类的患者，行涉及同种异体移植物的 rTHA。纳入 1990 年至 2021 年发表的至少随访 2 年的研究。应用 Kendall 相关分析来确定 Paprosky 分级与同种异体移植物使用类型之间的关系。进行比例荟萃分析，汇总各种重建方案（包括同种异体移植物类型、固定方法和重建系统）的成功率，采用 95%置信区间（CI）。
符合纳入标准的 27 项研究共纳入了 1491 例患者中的 1561 例，平均年龄为 64 岁（范围 22-95）。平均随访时间为 7.9 年（范围 2-22）。结构性大块和颗粒状移植物在所有 Paprosky 髋臼缺损类型中使用比例相等。其使用量随髋臼缺损类型显著增加（r=0.69，p=0.049）。总体成功率为 61.3%至 98.3%，随机效应汇总估计为 90%[95%CI 87-93]。骨小梁金属增压器（93%[76-98]）和外壳（97%[84-99]）的成功率最高。然而，未观察到重建系统、同种异体移植物类型和固定方法之间存在显著差异（所有比较 p>0.05）。
我们的研究结果强调了在不考虑 Paprosky 分类类型的情况下，使用大块或颗粒状同种异体移植物治疗大块骨丢失的情况，并表明使用同种异体移植物的不同髋臼重建方法具有相似的良好中至长期结果。
PROSPERO：CRD42020223093。
