From the Department of Arthroplasty, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India (Sanghavi), Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL (Paprosky), Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA (Sheth).
J Am Acad Orthop Surg. 2024 May 15;32(10):e466-e475. doi: 10.5435/JAAOS-D-23-00645. Epub 2024 Feb 27.
Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery. The use of cemented reconstruction techniques has declined, and contemporary practice trends have involved the increasing use of highly porous hemispherical shells in conjunction with modular porous metal augments, which can successfully treat most acetabular revisions. Noncemented treatment options for the management of acetabular bone loss during revision include conventional porous/modular highly porous hemispherical implants, nonmodular highly porous implants with cementable acetabular liners, cup-cage reconstruction, oblong cups, and triflange reconstruction. These options can be combined with modular porous metal augments, structural allografts, impaction grafting, or reconstruction cages. Acetabular distraction is a newer technique for chronic pelvic discontinuity, which is used in conjunction with off-the-shelf revision acetabular shells and modular porous metal augments. This review is an update over the past decade, highlighting studies with mid to long-term follow-up, and presents the advantages, disadvantages, and principles associated with each of the most commonly used reconstructive techniques.
髋臼骨量丢失仍然是骨科医生面临的最复杂和最具挑战性的情况之一。术前规划和分类系统基本上保持不变，其中 Paprosky 分类仍然是最常用的分类。术前仔细的影像学评估和明确的标准可以准确诊断髋臼骨量丢失模式，并在术前发现与慢性骨盆连续性中断相关的问题。骨水泥重建技术的使用有所减少，当代实践趋势涉及越来越多地使用高多孔半球形外壳与模块化多孔金属增强物相结合，这可以成功治疗大多数髋臼翻修。髋臼骨量丢失的非骨水泥治疗选择包括传统的多孔/模块化高多孔半球形植入物、带有可骨水泥髋臼衬垫的非模块化高多孔植入物、杯笼重建、长柄杯和三叶形重建。这些选择可以与模块化多孔金属增强物、结构性同种异体移植物、压配移植物或重建笼结合使用。髋臼牵张术是一种用于慢性骨盆连续性中断的新技术，与现成的髋臼翻修外壳和模块化多孔金属增强物联合使用。这篇综述是对过去十年的更新，重点介绍了具有中至长期随访的研究，并介绍了最常用的重建技术的优点、缺点和原则。
