D'Agostino Claudio, Di Martino Alberto, Cataldi Piergiorgio, Schilardi Francesco, Brunello Matteo, Geraci Giuseppe, Bordini Barbara, Traina Francesco, Faldini Cesare
1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
1st Orthopaedic and Traumatology Department, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy.
J Arthroplasty. 2025 Mar;40(3):738-743. doi: 10.1016/j.arth.2024.08.041. Epub 2024 Sep 2.
The increasing global performance of total hip arthroplasty (THA) has led to a rise in revision surgeries, primarily due to cup failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact, and osteointegration. The purpose of the study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survivorships, complications leading to re-revision, and surgical strategies in re-revision.
A cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 millimeters (mm) in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were "cup aseptic loosening" (54.5%) and "total aseptic loosening," which included both the cup and stem (32%).
The JC survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were "cup aseptic loosening" (40%), "total aseptic loosening" (17.1%), and "septic loosening" (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert or head revision (five cases).
This registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like antiprotrusion cages, bone grafts, and augments.
全球全髋关节置换术（THA）手术量的增加导致翻修手术增多，主要原因是髋臼杯失败，无菌性松动和假体周围感染是常见病因。各种技术和植入物，包括超大号髋臼杯（JCs），可处理髋臼杯取出后的残余骨量丢失，增加表面积以改善宿主骨接触和骨整合。本研究的目的是通过报告总体生存率、导致再次翻修的并发症以及再次翻修的手术策略，确定使用JC植入物进行髋臼翻修置换术在20年随访期内的结果。
基于一个大型区域登记处进行了一项队列研究，研究2000年至2020年间使用JCs的THA翻修手术。该研究纳入了所有使用非骨水泥型JCs进行的髋臼翻修手术，女性患者的JCs直径≥62毫米（mm），男性患者的JCs直径≥66毫米。所有髂骨固定杯均被排除。收集并分析了人口统计学数据、翻修手术指征、植入部件、固定类型、失败原因和再次干预策略。共评估了2000年1月至2020年12月期间植入的541个JCs。最常见的翻修指征是“髋臼杯无菌性松动”（54.5%）和“全无菌性松动”，包括髋臼杯和股骨柄（32%）。
JC的5年生存率为92.5%，10年生存率为85.8%，15年生存率为81.5%。在70例失败病例中，主要原因是“髋臼杯无菌性松动”（40%）、“全无菌性松动”（17.1%）和“感染性松动”（12.8%）。翻修主要涉及髋臼杯翻修手术（54例）、部件取出（11例）或衬垫或股骨头翻修（5例）。
这项基于登记处的关于THA翻修中JCs的研究显示了出色的15年生存率和可接受的失败率。它支持将JCs作为一种可行的选择，与防后凸笼、骨移植和增强装置等替代方案相比，手术相对简单。
