Hanusrichter Yannik, Gebert Carsten, Steinbeck Maximilian, Dudda Marcel, Hardes Jendrik, Frieler Sven, Jeys Lee M, Wessling Martin
Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.
Center for Musculoskeletal Surgery, Essen University Hospital, Essen, Germany.
Bone Jt Open. 2024 Aug 22;5(8):688-696. doi: 10.1302/2633-1462.58.BJO-2024-0029.R1.
Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction.
Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors.
Implantation was possible in all cases with a 2D centre of rotation deviation of 10 mm (SD 5.8; 1 to 29). PPR revision was necessary in eight (10%) patients. HHS increased significantly from 33 to 72 postoperatively, with a mean increase of 39 points (p < 0.001). Postoperative EQ-5D score was 0.7 (SD 0.3; -0.3 to 1). Risk factor analysis showed significant revision rates for septic indications (p ≤ 0.001) as well as femoral defect size (p = 0.001).
Since large acetabular defects are being treated surgically more often, custom-made PPR should be integrated as an option in treatment algorithms. Monoflange PPR, with primary iliac fixation, offers a viable treatment option for Paprosky III defects with promising functional results, while requiring less soft-tissue exposure and allowing immediate full weightbearing.
定制型部分骨盆置换术（PPR）在大型髋臼缺损重建中的应用日益增多，主要采用三翼缘设计，这需要广泛的软组织剥离。单翼缘设计预期可克服这一障碍，该设计通过在髂骨内进行初次髓内固定并结合单翼缘实现旋转稳定性。本研究旨在评估该设计在功能结局、并发症及髋臼重建方面的情况。
纳入2014年至2023年间的79例患者，平均随访33个月（标准差22；9至103个月）。使用Harris髋关节评分和欧洲五维健康量表（EQ - 5D）评估功能结局。将PPR翻修定义为终点，并对亚组进行分析以确定危险因素。
所有病例均成功植入，二维旋转中心偏差为10毫米（标准差5.8；1至29毫米）。8例（10%）患者需要进行PPR翻修。术后Harris髋关节评分从33分显著提高至72分，平均提高39分（p < 0.001）。术后EQ - 5D评分为0.7（标准差0.3；-0.3至1）。危险因素分析显示，感染指征（p ≤ 0.001）以及股骨缺损大小（p = 0.001）的翻修率显著。
鉴于大型髋臼缺损的手术治疗日益增多，定制型PPR应作为治疗方案中的一种选择。采用初次髂骨固定的单翼缘PPR为Paprosky III型缺损提供了一种可行的治疗选择，功能结果良好，同时所需的软组织暴露较少，并允许立即完全负重。
