Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2024 Sep;39(9S1):S194-S202. doi: 10.1016/j.arth.2024.03.071. Epub 2024 Apr 9.
Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship.
Between 2000 and 2012, 157 revision THAs were performed in cases with major acetabular defects (mainly Paprosky type IIIA and IIIB) utilizing porous tantalum cup-augment constructs. Pelvic discontinuity was noted intraoperatively in 17 hips (11%). Postoperative radiographs were evaluated at regular intervals for implant stability and radiolucent lines. There were 49 patients who had complete radiographic follow-up at 10 years or longer postsurgery.
The 10-year survivorship free of revision of the cup-augment construct for aseptic loosening was 93%, free of any acetabular construct revision was 91%, free of any hip rerevision was 77%, and free of any reoperation was 75%. Pelvic discontinuity was associated with increased risk of reoperation (hazard ratio [HR] = 2.8), any hip rerevision (HR = 3.2), any cup-augment construct revision (HR = 11.8), and aseptic construct revision (HR = 10.0). Of unrevised cases with radiographs at 10 years, 4 hips showed radiographic loosening. Mean Harris hip scores improved from 47 preoperatively to 79 at 10 years.
Porous tantalum acetabular cup-augment constructs used in revision THA with severe acetabular bone loss provide excellent implant survivorship at 10 years when the acetabulum is intact. Due to lower survivorship of cup-augment constructs in cases of pelvic discontinuity, additional construct fixation or stabilization methods are recommended, when a discontinuity is present.
IV.
多孔钽髋臼杯和增强结构在翻修全髋关节置换术 (THA) 中即使存在严重的骨质丢失，术后 5 年仍能获得良好的结果。先前的文献缺乏大量病例的长期研究。本研究旨在评估 10 年后接受多孔钽髋臼杯-增强结构翻修 THA 治疗的患者的长期临床和影像学结果，并确定与长期生存率相关的因素。
在 2000 年至 2012 年间，对 157 例主要髋臼缺损（主要为 Paprosky 型 IIIA 和 IIIB）的翻修 THA 病例采用多孔钽杯-增强结构进行治疗。术中发现 17 髋（11%）存在骨盆不连续。术后定期拍摄 X 线片评估植入物稳定性和透亮线。有 49 例患者在术后 10 年或更长时间进行了完整的影像学随访。
10 年无无菌性松动翻修的髋臼杯-增强结构生存率为 93%，无任何髋臼结构翻修的生存率为 91%，无任何髋关节再翻修的生存率为 77%，无任何再次手术的生存率为 75%。骨盆不连续与翻修风险增加相关（风险比 [HR] = 2.8），任何髋关节再翻修（HR = 3.2），任何髋臼杯-增强结构翻修（HR = 11.8），以及无菌结构翻修（HR = 10.0）。在 X 线片随访 10 年的未翻修病例中，有 4 髋出现影像学松动。术前平均 Harris 髋关节评分从 47 分提高到 10 年时的 79 分。
在髋臼骨质严重丢失的翻修 THA 中使用多孔钽髋臼杯-增强结构，如果髋臼完整，10 年后可获得极好的植入物生存率。由于骨盆不连续时髋臼杯-增强结构的生存率较低，因此建议在存在不连续时采用额外的结构固定或稳定方法。
IV 级。
