Kaplan Nathan B, Barra Matthew F, Jubril Ayodeji, Knapp Emma, Awad Hani, Ginnetti John
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, USA.
Department of Orthopaedics and Rehabilitation/Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, USA.
Cureus. 2023 Apr 28;15(4):e38257. doi: 10.7759/cureus.38257. eCollection 2023 Apr.
Revision total hip arthroplasty in the setting of acetabular bone loss remains a challenging clinical entity. Deficiencies of the acetabular rim, walls, and/or columns may limit the bony surface area and initial acetabular construct stability necessary for osseointegration of cementless components. Press-fit acetabular components with supplemental acetabular screw fixation represent a common technique aimed to minimize implant micromotion and allow for definitive osseointegration. Although acetabular screw fixation is commonly practiced in revision hip arthroplasty, few studies to date have examined the screw properties associated with maximal acetabular construct stability. The purpose of the present report is to examine acetabular screw fixation in a pelvis model mimicking Paprosky IIB acetabular bone loss.
Measuring bone-implant interface micromotion as a surrogate for initial implant stability, experimental models assessed the effect of screw number, screw length, and screw position on construct stability subject to a cyclic loading protocol designed to replicate joint reaction forces of two common daily activities.
Trends towards increasing stability were demonstrated with increasing screw number, increasing screw length, and concentrating screws in the supra-acetabular dome. All experimental constructs yielded micromotion levels sufficient for bone ingrowth, except when screws in the dome were moved to the pubis and ischium.
When using a porous coated revision acetabular implant to treat Paprosky IIB defects, screws should be used, and furthermore, increasing number, length, and position within the acetabular dome may help further stabilize the construct.
在髋臼骨量丢失的情况下进行全髋关节翻修置换术仍然是一个具有挑战性的临床问题。髋臼边缘、壁和/或柱的缺损可能会限制骨表面积以及非骨水泥型假体骨整合所需的初始髋臼结构稳定性。采用补充髋臼螺钉固定的压配式髋臼假体是一种常用技术，旨在将假体微动降至最低并实现确定性骨整合。虽然髋臼螺钉固定在髋关节翻修置换术中普遍应用，但迄今为止，很少有研究探讨与最大髋臼结构稳定性相关的螺钉特性。本报告的目的是在模拟Paprosky IIB型髋臼骨量丢失的骨盆模型中研究髋臼螺钉固定情况。
通过测量骨-假体界面微动作为初始假体稳定性的指标，实验模型评估了螺钉数量、螺钉长度和螺钉位置对结构稳定性的影响，实验采用了一种循环加载方案，旨在模拟两项常见日常活动的关节反应力。
随着螺钉数量增加、螺钉长度增加以及螺钉集中在髋臼上穹顶，稳定性呈增加趋势。除了将穹顶处的螺钉移至耻骨和坐骨时，所有实验结构产生的微动水平都足以促进骨长入。
在使用多孔涂层翻修髋臼假体治疗Paprosky IIB型缺损时，应使用螺钉，此外，增加螺钉数量、长度以及在髋臼穹顶内的位置可能有助于进一步稳定结构。
