University of Toronto Temerty Faculty of Medicine, Toronto, Canada.
Mount Sinai Hospital, Gluskin Granovsky Division of Orthopaedics, Toronto, Canada.
Bone Joint J. 2024 May 1;106-B(5 Supple B):66-73. doi: 10.1302/0301-620X.106B5.BJJ-2023-0842.R1.
Pelvic discontinuity is a challenging acetabular defect without a consensus on surgical management. Cup-cage reconstruction is an increasingly used treatment strategy. The present study evaluated implant survival, clinical and radiological outcomes, and complications associated with the cup-cage construct.
We included 53 cup-cage construct (51 patients) implants used for hip revision procedures for pelvic discontinuity between January 2003 and January 2022 in this retrospective review. Mean age at surgery was 71.8 years (50.0 to 92.0; SD 10.3), 43/53 (81.1%) were female, and mean follow-up was 6.4 years (0.02 to 20.0; SD 4.6). Patients were implanted with a Trabecular Metal Revision Shell with either a ZCA cage (n = 12) or a TMARS cage (n = 40, all Zimmer Biomet). Pelvic discontinuity was diagnosed on preoperative radiographs and/or intraoperatively. Kaplan-Meier survival analysis was performed, with failure defined as revision of the cup-cage reconstruction.
The five-year all-cause survival for cup-cage reconstruction was 73.4% (95% confidence interval (CI) 61.4 to 85.4), while the ten- and 15-year survival was 63.7% (95% CI 46.8 to 80.6). Survival due to aseptic loosening was 93.4% (95% CI 86.2 to 100.0) at five, ten, and 15 years. The rate of revision for aseptic loosening, infection, and dislocation was 3/53 (5.7%), 7/53 (13.2%), and 6/53 (11.3%), respectively. The mean leg length discrepancy improved (p < 0.001) preoperatively from a mean of 18.2 mm (0 to 80; SD 15.8) to 7.0 mm (0 to 35; SD 9.8) at latest follow-up. The horizontal and vertical hip centres improved (p < 0.001) preoperatively from a mean of 9.2 cm (5.6 to 17.5; SD 2.3) to 10.1 cm (6.2 to 13.4; SD 2.1) and 9.3 cm (4.7 to 15.8; SD 2.5) to 8.0 cm (3.7 to 12.3; SD 1.7), respectively.
Cup-cage reconstruction provides acceptable outcomes in the management of pelvic discontinuity. One in four constructs undergo revision within five years, most commonly for periprosthetic joint infection, dislocation, or aseptic loosening.
骨盆不连续是一种具有挑战性的髋臼缺损，其手术治疗尚无共识。杯笼重建是一种越来越常用的治疗策略。本研究评估了杯笼结构的植入物存活率、临床和影像学结果以及相关并发症。
我们回顾性分析了 2003 年 1 月至 2022 年 1 月期间，因骨盆不连续而行髋关节翻修手术的 53 例（51 例患者）杯笼重建（杯笼结构）植入物。手术时的平均年龄为 71.8 岁（50.0 至 92.0；SD 10.3），43/53（81.1%）为女性，平均随访时间为 6.4 年（0.02 至 20.0；SD 4.6）。患者接受了 Trabecular Metal Revision Shell 与 ZCA 笼（n=12）或 TMARS 笼（n=40，均为 Zimmer Biomet）联合植入。术前影像学检查和/或术中诊断为骨盆不连续。采用 Kaplan-Meier 生存分析，以杯笼重建的翻修为失败标准。
杯笼重建的 5 年全因存活率为 73.4%（95%置信区间（CI）61.4 至 85.4），10 年和 15 年的存活率分别为 63.7%（95% CI 46.8 至 80.6）。5 年、10 年和 15 年时，因无菌性松动导致的存活率分别为 93.4%（95% CI 86.2 至 100.0）。无菌性松动、感染和脱位的翻修率分别为 3/53（5.7%）、7/53（13.2%）和 6/53（11.3%）。术前平均下肢长度差异显著改善（p<0.001），从术前的 18.2 毫米（0 至 80；SD 15.8）到末次随访时的 7.0 毫米（0 至 35；SD 9.8）。术前髋关节水平和垂直中心显著改善（p<0.001），从术前的 9.2 厘米（5.6 至 17.5；SD 2.3）至 10.1 厘米（6.2 至 13.4；SD 2.1）和 9.3 厘米（4.7 至 15.8；SD 2.5）至 8.0 厘米（3.7 至 12.3；SD 1.7）。
杯笼重建在骨盆不连续的治疗中提供了可接受的结果。四分之一的植入物在 5 年内需要翻修，最常见的原因是假体周围关节感染、脱位或无菌性松动。
