Clinique des Vergers, chemin de la Planche 1, 1217 Meyrin, Switzerland.
Institut du Mouvement et de l'appareil locomoteur, Aix Marseille Université - Assistance publique des Hôpitaux de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
Orthop Traumatol Surg Res. 2024 Apr;110(2):103739. doi: 10.1016/j.otsr.2023.103739. Epub 2023 Oct 31.
Porous tantalum components and augments have demonstrated short to midterm fixation stability in acetabular total hip arthroplasty (THA) revision but do not offer a novel option to decrease the postoperative dislocation rate. Recently, dual mobility (DM) cups have gained interest to decrease the prevalence of recurrent hip instability after revision hip arthroplasty, but this issue was not confirmed combined with use of tantalum reconstruction devices. Therefore, we did a retrospective study aiming to: (1) evaluate at a 5-year minimum follow-up period the dislocation rate (and other intra- and postoperative complications), (2) assess radiographic results specifically looking at osseointegration and restoration of the hip center, (3) and also clinical results in a cohort of patients who underwent complex acetabular reconstruction with trabecular metal revision components associated with a cemented DM socket.
Using a DM socket cemented in porous tantalum components can reach the low risk of hip dislocation reported with DM components in revision setting without increasing the risk of a mechanical failure.
A cross-sectional study identified 174 THA revision including an acetabular revision. Were excluded 118 revisions with acetabular defects Type 1, 2a or 2B according to Paprosky's classification, as well as 18 hips revised without a dual mobility and 3 patients (3 hips) lost to follow-up. Were thus included in this study 35 hips (35 patients) implanted with uncemented total hip arthroplasty revision using both trabecular metal acetabular cup-cage reconstruction and a cemented DM cup. Seven hips were classified Paprosky types 2C, 15 type 3A and 13 types 3B. Patients were followed with clinical and radiological evaluation regarding dislocation rate, infection, reoperation or re-revision, osseointegration and restoration of the hip center, and functional results according to the Harris hip score and psoas impingement presence.
At a mean follow-up of 8.1±1.8 years (5.1-12.6), one dislocation was recorded, and one acute deep infection. No patient required a cup re-revision for septic or aseptic loosening. The survivorship at 8years regarding revision for any cause as an endpoint was 96.5% (CI95%: 92-99). Osseointegration of TM implants was analyzed and found no acetabular migration at the last follow-up in the cohort. The mean hip center position was optimized from 48±7mm (37-58) to 34±5mm (29-39) vertically and from 26±5mm (-18-36) to 24±8mm (7-31) horizontally without reaching significance (p=0.1). On the last follow-up X-rays, the mean acetabular inclination was 47̊±9̊ (32̊-61̊). According to the criteria of Hirakawa, 97.1% (34/35) of the hip centers were restored. One cup (2.9%) was more than 5mm proximally from the hip center, and none more than 10mm. Clinical results assessed a Harris Hip Score improved from 36±17 (23-62) preoperatively to 82±15 (69-93) at last follow-up (p<0.0001). Two patients (2/35, 5.7%) complained of psoas impingement.
This study suggests effectiveness of DM cups in association with a tantalum-made acetabular shell for reconstruction of large bone defect in THRs for both solving postoperative instability and aseptic loosening without increasing the re-revision rate for any reason in a midterm follow-up.
IV; observational study.
多孔钽部件和增材已在髋臼全髋关节置换术 (THA) 翻修中证明了短期至中期固定稳定性，但不能提供降低术后脱位率的新选择。最近，双动 (DM) 杯已引起人们的兴趣，以降低髋关节翻修后髋关节再次不稳定的发生率，但在与钽重建装置联合使用时，这一问题并未得到证实。因此，我们进行了一项回顾性研究，旨在：(1) 在至少 5 年的随访期内评估脱位率（和其他术中及术后并发症），(2) 专门评估影像学结果，重点关注骨整合和髋关节中心的恢复，(3) 以及在一组接受复杂髋臼重建的患者中评估临床结果，这些患者使用多孔钽组件联合骨水泥 DM 窝进行治疗。
使用骨水泥 DM 窝固定在多孔钽组件中，可以达到 DM 组件在翻修时报告的低髋关节脱位风险，而不会增加机械故障的风险。
一项横断面研究确定了 174 例 THA 翻修，其中包括髋臼翻修。排除了根据 Paprosky 分类为髋臼缺损 1 型、2a 型或 2B 型的 118 例翻修，以及未使用双动和 3 例（3 髋）失访的 18 例髋关节翻修。因此，本研究纳入了 35 例（35 髋）植入非骨水泥全髋关节翻修，使用多孔金属髋臼杯笼重建和骨水泥 DM 杯。7 髋为 Paprosky 3C 型，15 髋为 3A 型，13 髋为 3B 型。患者通过临床和影像学评估，包括脱位率、感染、再次手术或再翻修、骨整合和髋关节中心的恢复，以及根据 Harris 髋关节评分和腰大肌撞击存在情况评估功能结果。
平均随访 8.1±1.8 年（5.1-12.6），记录到 1 例脱位，1 例急性深部感染。没有患者因感染或无菌性松动需要再次翻修杯。8 年时因任何原因进行翻修的生存率为 96.5%（95%CI：92-99）。分析了 TM 植入物的骨整合情况，发现最后一次随访时，在该队列中髋臼无迁移。髋关节中心位置从平均 48±7mm（37-58）优化至 34±5mm（29-39）垂直方向和 26±5mm（-18-36）至 24±8mm（7-31）水平方向，但无统计学意义（p=0.1）。最后一次随访的 X 线片上，髋臼倾斜平均为 47̊±9̊（32̊-61̊）。根据 Hirakawa 的标准，97.1%（34/35）的髋关节中心得到了恢复。1 个杯（2.9%）距髋关节中心近端超过 5mm，没有超过 10mm。临床结果评估显示，Harris 髋关节评分从术前的 36±17（23-62）改善至最后一次随访时的 82±15（69-93）（p<0.0001）。2 名患者（2/35，5.7%）抱怨腰大肌撞击。
本研究表明，在解决术后不稳定和无菌性松动方面，DM 杯联合多孔钽髋臼壳在 THR 中的重建具有有效性，在中期随访中不会增加任何原因的再次翻修率。
IV；观察性研究。
