Shaarani Shahril R, Jaibaji Monketh, Yaghmour Khaled M, Vles Georges, Haddad Fares S, Konan Sujith
Department of Trauma & Orthopaedics, University College London Hospital, London, NW1 2BU, UK.
University College London, London, NW1 2BU, UK.
Arthroplasty. 2023 May 8;5(1):24. doi: 10.1186/s42836-023-00177-4.
Extensive acetabular bone loss and poor bone quality are two key challenges often encountered in revision total hip arthroplasty. A new 3D-printed porous acetabular shell has been made available with the option to insert multiple variable-angle locking screws. We sought to evaluate the early clinical and radiological outcomes of this construct.
A retrospective review of patients operated by two surgeons was performed in a single institution. Fifty-nine revision hip arthroplasties were performed in 55 patients (34 female; mean age 68.8 ± 12.3 years) for Paprosky defects I (n = 21), IIA/B (n = 22), IIC (n = 9), III (n = 7) between February 2018 and January 2022 using the novel porous titanium acetabular shell and multiple variable angle locking screws. Postoperative clinical and radiographic outcomes were locally maintained. Patient-reported outcome measures collected included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score, and the 12-item Short Form Survey.
After a mean follow-up of 25.7 ± 13.9 months, two cases of shell migration were noted. One patient had a failed constrained mechanism and received revision to a cemented dual mobility liner. No other acetabular shells showed any evidence of radiographic loosening at the final follow-up. Preoperatively, 21 defects were classified as Paprosky grade I, 19 grade IIA, 3 grade IIB, 9 IIC, 4 grade IIIA, and 3 IIIB. The mean postoperative WOMAC function score was 84 (SD 17), WOMAC (stiffness) 83 (SD 15), WOMAC (pain) 85 (SD 15), and WOMAC (global) 85 (SD 17). The mean postoperative OHS was 83 (SD 15), and mean SF-12 physical score was 44 (SD 11).
The additional augmentation of porous metal acetabular shells with multiple variable-angle locking screws provides reliable initial fixation with good clinical and radiological outcomes in the short term. Further studies are needed to establish the medium- and long-term outcomes.
IV.
广泛的髋臼骨丢失和较差的骨质是翻修全髋关节置换术中经常遇到的两个关键挑战。一种新型的3D打印多孔髋臼杯已可供使用，并可选择插入多个可变角度锁定螺钉。我们试图评估这种结构的早期临床和影像学结果。
在单一机构对由两位外科医生实施手术的患者进行回顾性研究。2018年2月至2022年1月期间，对55例患者（34例女性；平均年龄68.8±12.3岁）进行了59例翻修髋关节置换术，用于治疗Paprosky I型（n=21）、IIA/B型（n=22）、IIC型（n=9）、III型（n=7）骨缺损，采用新型多孔钛髋臼杯和多个可变角度锁定螺钉。术后临床和影像学结果在当地进行了记录。收集的患者报告结局指标包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、牛津髋关节评分和12项简明健康调查。
平均随访25.7±13.9个月后，发现2例髋臼杯移位。1例患者的限制性机制失败，接受了骨水泥双动衬垫翻修。在最后一次随访时，没有其他髋臼杯显示出任何影像学松动的迹象。术前，21处骨缺损被分类为Paprosky I级，19处为IIA级，3处为IIB级，9处为IIC级，4处为IIIA级，3处为IIIB级。术后WOMAC功能评分平均为84（标准差17）分[WOMAC（僵硬）83（标准差15）分，WOMAC（疼痛）85（标准差15）分，WOMAC（总体）85（标准差17）分]。术后牛津髋关节评分平均为83（标准差15）分，简明健康调查12项身体评分平均为44（标准差11）分。
多孔金属髋臼杯附加多个可变角度锁定螺钉可提供可靠的初始固定，短期内临床和影像学结果良好。需要进一步研究以确定中长期结果。
IV级
