Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK.
Bone Joint J. 2024 May 1;106-B(5 Supple B):47-53. doi: 10.1302/0301-620X.106B5.BJJ-2023-0809.R1.
The aims of this study were to determine the success of a reconstruction algorithm used in major acetabular bone loss, and to further define the indications for custom-made implants in major acetabular bone loss.
We reviewed a consecutive series of Paprosky type III acetabular defects treated according to a reconstruction algorithm. IIIA defects were planned to use a superior augment and hemispherical acetabular component. IIIB defects were planned to receive either a hemispherical acetabular component plus augments, a cup-cage reconstruction, or a custom-made implant. We used national digital health records and registry reports to identify any reoperation or re-revision procedure and Oxford Hip Score (OHS) for patient-reported outcomes. Implant survival was determined via Kaplan-Meier analysis.
A total of 105 procedures were carried out in 100 patients (five bilateral) with a mean age of 73 years (42 to 94). In the IIIA defects treated, 72.0% (36 of 50) required a porous metal augment; the remaining 14 patients were treated with a hemispherical acetabular component alone. In the IIIB defects, 63.6% (35 of 55) underwent reconstruction as planned with 20 patients who actually required a hemispherical acetabular component alone. At mean follow-up of 7.6 years, survival was 94.3% (95% confidence interval 97.4 to 88.1) for all-cause revision and the overall dislocation rate was 3.8% (4 of 105). There was no difference observed in survival between type IIIA and type IIIB defects and whether a hemispherical implant alone was used for the reconstruction or not. The mean gain in OHS was 16 points. Custom-made implants were only used in six cases, in patients with either a mega-defect in which the anteroposterior diameter > 80 mm, complex pelvic discontinuity, and massive bone loss in a small pelvis.
Our findings suggest that a reconstruction algorithm can provide a successful approach to reconstruction in major acetabular bone loss. The use of custom implants has been defined in this series and accounts for < 5% of cases.
本研究旨在确定一种在严重髋臼骨缺损中使用的重建算法的成功率，并进一步定义在严重髋臼骨缺损中使用定制植入物的适应证。
我们回顾了一系列按照重建算法治疗的 Paprosky Ⅲ型髋臼缺损的连续病例。ⅢA 型缺损计划使用上侧增容和半球形髋臼组件。ⅢB 型缺损计划接受半球形髋臼组件加增容、杯笼重建或定制植入物。我们使用国家数字健康记录和登记报告来识别任何再次手术或再次修订的程序，以及牛津髋关节评分（OHS）作为患者报告的结果。通过 Kaplan-Meier 分析确定植入物的存活率。
共对 100 名患者（5 例双侧）的 105 例手术进行了研究，平均年龄为 73 岁（42 至 94 岁）。在治疗的ⅢA 型缺损中，72.0%（50 例中的 36 例）需要使用多孔金属增容；其余 14 例仅接受半球形髋臼组件治疗。在ⅢB 型缺损中，63.6%（55 例中的 35 例）按照计划进行了重建，其中 20 例实际上仅需要使用半球形髋臼组件。在平均 7.6 年的随访中，所有原因的翻修的存活率为 94.3%（95%置信区间为 97.4%至 88.1%），总体脱位率为 3.8%（105 例中的 4 例）。ⅢA 型和ⅢB 型缺损之间以及是否单独使用半球形植入物进行重建的存活率无差异。OHS 的平均增益为 16 分。定制植入物仅在 6 例患者中使用，这些患者要么存在前-后直径>80mm 的巨大缺损，要么骨盆连续性复杂，要么小骨盆中存在大量骨丢失。
我们的研究结果表明，重建算法可以为严重髋臼骨缺损的重建提供成功的方法。在本系列中已经确定了定制植入物的使用，占病例的<5%。
