Servicio de Traumatología y Ortopedia, Hospital General del Puerto de Santa Maria, Grupo Hospitalario Pascual, Puerto de Santa Maria, Cadiz, Españ.
Servicio de Reumatologia, Hospital General del Puerto de Santa Maria, Grupo Hospitalario Pascual, Puerto de Santa Maria, Cadiz, España.
Ortop Traumatol Rehabil. 2024 Apr 30;26(2):11-20. doi: 10.5604/01.3001.0054.6545.
Total hip arthroplasty in patients with rheumatoid arthritis is difficult and leads to worse implant survival and higher risk for complications compared to osteoarthritis. Poor periacetabular bone quality might challenge the stability of the acetabular cup. Contemporary 3D-printed highly-porous titanium cup designs have become the benchmark for cementless implants; however, their usefulness in rheumatoid arthritis is still unclear. The purpose of this study was to assess the short-term results of the use of a highly-porous 3D-printed acetabular titanium cup in patients with rheumatoid arthritis.
We studied a consecutive series of RA patients who underwent cementless THA between 2019 and 2020 in our center with the same 3D-printed highly-porous titanium acetabular cup. All patients were evaluated prospectively for a minimum 3-year follow-up with the Harris hip score, VAS and Roles and Maudsley score. Radiographic assessment focused on evidence of cup osseointegration.
37 RA patients, mean age at surgery of 51.3 years, were included. Mean follow-up was 3.2 years (3 to 4 years). By the last follow-up visit, the Harris hip score had increased significantly from 37.8 to 88.5, VAS had decreased from 6.1 to 1.0 and excellent satisfaction for 31 patients. All 5 Moore's radiographic signs were present in 35 hips, with only 4 signs present in the remaining 2 hips, thus indicating complete osseointegration of all cups. There were no complications on the acetabular side but one intraoperative proximal calcar fracture.
3D-printed highly porous implants used in primary THA worked well in patients with rheumatoid arthritis, showing excellent osseointegration and good clinical results in the short term.
与骨关节炎相比，类风湿关节炎患者的全髋关节置换术难度更大，导致植入物存活率更低，并发症风险更高。髋臼周围骨质量差可能会影响髋臼杯的稳定性。当代 3D 打印的高多孔钛髋臼杯设计已成为无水泥植入物的基准；然而，它们在类风湿关节炎中的应用仍不清楚。本研究旨在评估在类风湿关节炎患者中使用高多孔 3D 打印髋臼钛杯的短期效果。
我们研究了 2019 年至 2020 年期间在我们中心接受无水泥 THA 的连续系列类风湿关节炎患者，使用相同的 3D 打印高多孔钛髋臼杯。所有患者均前瞻性评估，随访时间至少 3 年，采用 Harris 髋关节评分、VAS 和 Roles 和 Maudsley 评分进行评估。影像学评估重点关注杯骨整合的证据。
37 例类风湿关节炎患者，手术时平均年龄为 51.3 岁，平均随访时间为 3.2 年（3 至 4 年）。在最后一次随访时，Harris 髋关节评分从 37.8 显著增加到 88.5，VAS 从 6.1 降低到 1.0，31 例患者满意度极佳。35 髋中有 5 髋出现 Moore 所有 5 项影像学征象，其余 2 髋仅出现 4 项影像学征象，表明所有髋臼杯均完全骨整合。髋臼侧无并发症，但有 1 例术中近端骺板骨折。
在原发性 THA 中使用的 3D 打印高多孔植入物在类风湿关节炎患者中效果良好，短期内表现出良好的骨整合和良好的临床效果。
