Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2024 Sep;39(9S2):S398-S403. doi: 10.1016/j.arth.2024.02.036. Epub 2024 Feb 23.
Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity.
Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct.
Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up.
To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique.
Level III, Retrospective Comparative Study.
慢性骨盆不连续性是翻修全髋关节置换术的一个挑战，因为严重髋臼骨质丢失导致髋臼上下表面的结构连续性丧失。髋臼牵张术通过骨盆的弹性回弹为髋臼部件提供了一种替代的手术治疗方法，这可能通过使用模块化多孔增材来解决主要的髋臼缺陷。本研究报告了 5 名医生在 2002 年至 2021 年期间对 5 家机构的 53 例（5 例死亡，33 例失访）慢性骨盆不连续性患者行髋臼牵张术的 2 年放射学结果。记录了患者的人口统计学、手术和术后结果，包括放射学组件稳定性。包括 4 例 Paprosky IIC（7.5%）、8 例 Paprosky IIIA（15.1%）和 41 例 Paprosky IIIB（77.4%）缺陷在内的 53 例患者接受了髋臼牵张术，平均随访时间为 4.8 年（范围 2 至 13.5 年）。33 例（62.3%）患者使用了模块化多孔增材。失败定义为髋臼结构的后续翻修。
在返回手术室的 13 例（24.5%）患者中，6 例（46.2%）在接受髋臼牵张术前有全髋关节翻修史。仅 5 例（9.4%）患者在髋臼牵张术后行髋臼翻修术，导致髋臼杯总体生存率为 90.6%。在其余 48 例患者中，46 例（95.8%）在末次临床随访时，慢性骨盆不连续性处有放射学桥接性骨痂的证据。
据我们所知，在目前为止最大的系列研究中，髋臼牵张术已被证明是治疗慢性骨盆不连续性髋臼骨丢失的一种可行方法，具有极好的早期生存率和放射学桥接性骨痂的证据。需要进行更长时间随访的进一步研究来进一步监测该技术的疗效。
三级，回顾性比较研究。
