Department of Orthopaedics, University Hospital Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
Int Orthop. 2024 Dec;48(12):3083-3090. doi: 10.1007/s00264-024-06334-x. Epub 2024 Sep 27.
Acetabular defect reconstruction can be a complex and challenging surgical procedure, with stable long-term fixation of the implants remaining the ultimate goal. The purpose of this study was (1) to evaluate the radiological and clinical outcome of complex acetabular reconstruction surgery with the use of modular tantalum TM augments in combination with cemented revision cups; (2) to investigate blood tantalum concentrations in these patients; and (3) to report complications and mechanisms of failure related to this procedure at mid-term follow-up (mean 4.5 years).
We retrospectively reviewed 29 patients (29 hips) with severe acetabular bone loss (Paprosky type III A) reconstructed using a modular tantalum TM augment in combination with a cemented cup. We evaluated the implant survival and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.2; range 8.4 - 2.1 years) using patient reported outcome scores (PROMs). Blood samples were analysed regarding tantalum concentration and compared with a control group.
The cumulative survival rate at 4.5 years with the endpoint "revision of the acetabular component for any reason" was 96.2% (95% Confidence Interval 75.7-99.5). The PROMs improved significantly up to the latest follow-up, and radiographic data showed only one patient with signs of initial implant migration with a broken screw and a change of the position of the augment and the cup. Mean blood tantalum concentrations were significantly higher in the study group (0.16 µg/L) compared to the control group (0.002 µg/L) (P < 0.001).
This study has demonstrated good mid-term (mean 4.5 years) clinical and radiological outcomes of modular tantalum TM augments in combination with a cemented cup for the reconstruction of major acetabular defects. Mean blood tantalum concentrations were increased in patients with stable tantalum implants compared to healthy controls.
髋臼缺损重建是一项复杂且具有挑战性的手术，其最终目标是实现植入物的稳定长期固定。本研究的目的是：(1) 评估使用模块化钽 TM 增强物结合骨水泥翻修杯进行复杂髋臼重建手术的放射学和临床结果；(2) 研究这些患者的血钽浓度；(3) 报告中期（平均 4.5 年）随访时与该手术相关的并发症和失败机制。
我们回顾性分析了 29 例（29 髋）严重髋臼骨缺损（Paprosky Ⅲ A 型）患者，使用模块化钽 TM 增强物结合骨水泥杯进行重建。我们使用患者报告的结果评分（PROMs）评估了平均 4.5 年（标准差 2.2；范围 8.4-2.1 年）后的植入物存活率和放射学及临床结果。分析了血样中的钽浓度，并与对照组进行了比较。
在 4.5 年时，以“任何原因翻修髋臼部件”为终点的累积生存率为 96.2%（95%置信区间 75.7-99.5）。PROMs 一直显著改善，直到最近的随访，放射学数据仅显示 1 例患者有初始植入物迁移的迹象，伴有螺钉断裂、增强物和杯位置改变。研究组的平均血钽浓度（0.16µg/L）明显高于对照组（0.002µg/L）（P<0.001）。
本研究表明，在重建大髋臼缺损时，使用模块化钽 TM 增强物结合骨水泥杯具有良好的中期（平均 4.5 年）临床和放射学结果。与健康对照组相比，稳定的钽植入物患者的平均血钽浓度增加。
