Nogier Alexis, Tourabaly Idriss, Ramos-Pascual Sonia, Debiesse Jean-Louis, Chen Antonia F, Saffarini Mo, Courtin Cyril
Orthopaedic Surgery Department, Clinique Trenel, Sainte-Colombe, France.
Orthopaedic Surgery Department, Clinique Maussins-Nollet, Paris, France.
Hip Int. 2025 Sep;35(5):456-466. doi: 10.1177/11207000241304095. Epub 2024 Dec 10.
To assess clinical and radiographic outcomes of anterior acetabular wall reconstruction and cup revision in patients with anterior acetabular wall defects and associated iliopsoas tendinopathy (IPT) following total hip arthroplasty (THA).
7 patients with IPT (defined as groin pain that increased with active hip flexion) and pre-revision computed tomography (CT) scans showing anterior acetabular wall defects and cup-iliopsoas impingement were included. During cup revision, an autologous biconvex iliac crest graft was harvested and placed over the anterior acetabular wall defect before press-fitting a revision cup. Cup inclination and anteversion, axial and sagittal cup overhang, and iliopsoas muscle strength (0-5) were evaluated pre- and post-revision. Forgotten joint score (FJS; 0-100), Oxford hip score (OHS; 0-48), hip pain (0-10), satisfaction (0-10), graft osseointegration and resorption were evaluated post-revision.
Pre-revision cup inclination was 43.7 ± 9.4°, anteversion was 30.4 ± 10.5°, axial overhang was 6.6 ± 7.9 mm, and sagittal overhang was 14.2 ± 4.8 mm. Immediate post-revision cup anteversion was 33.0 ± 7.9°, inclination was 45.3 ± 5.1°, while there was no axial or sagittal overhang. At 60.3 ± 5.6 (52-70) months follow-up, 6 of 7 patients were available for assessment (1 patient had died). Iliopsoas muscle strength increased from 3.9 ± 0.7 to 4.6 ± 0.9, FJS was 77.5 ± 32.8, OHS was 40.3 ± 12.8, hip pain on VAS was 0.2 ± 0.4 at rest and 2.3 ± 2.6 during activities. Patient satisfaction with surgery was 8.3 ± 2.3, but 1 patient was dissatisfied and reported persistent hip pain. Last follow-up CT scans were available for 4 of 7 patients, with 3 showing osseointegrated grafts and no graft resorption.
Anterior acetabular wall reconstruction and cup revision resulted in satisfactory clinical outcomes at a minimum follow-up of 4 years in 5 of 7 cases. Most patients fully recovered their iliopsoas muscle strength, had minimal to no pain, excellent FJS, and an osseointegrated acetabular wall graft.
评估全髋关节置换术（THA）后髋臼前壁缺损及相关髂腰肌肌腱病（IPT）患者行髋臼前壁重建及髋臼杯翻修的临床和影像学结果。
纳入7例IPT患者（定义为主动髋关节屈曲时腹股沟疼痛加重），术前翻修计算机断层扫描（CT）显示髋臼前壁缺损及髋臼杯 - 髂腰肌撞击。在髋臼杯翻修过程中，取一块自体双凸髂嵴骨块，置于髋臼前壁缺损处，然后压配入翻修髋臼杯。评估翻修前后髋臼杯的倾斜度和前倾角、轴向和矢状面髋臼杯悬出情况以及髂腰肌力量（0 - 5级）。翻修后评估遗忘关节评分（FJS；0 - 100）、牛津髋关节评分（OHS；0 - 48）、髋关节疼痛（0 - 10）、满意度（0 - 10）、骨块骨整合及吸收情况。
翻修前髋臼杯倾斜度为43.7±9.4°，前倾角为30.4±10.5°，轴向悬出为6.6±7.9mm，矢状面悬出为14.2±4.8mm。翻修后即刻髋臼杯前倾角为33.0±7.9°，倾斜度为45.3±5.1°，且无轴向或矢状面悬出。在60.3±5.6（52 - 70）个月的随访中，7例患者中有6例可进行评估（1例患者死亡）。髂腰肌力量从3.9±0.7增加到4.6±0.9，FJS为77.5±32.8，OHS为40.3±12.8，静息时VAS髋关节疼痛评分为0.2±0.4，活动时为2.3±2.6。患者对手术的满意度为8.3±2.3，但有1例患者不满意并报告持续存在髋关节疼痛。7例患者中有4例可获得末次随访CT扫描结果，其中3例显示骨块骨整合且无骨块吸收。
髋臼前壁重建及髋臼杯翻修在7例患者中的5例至少4年的随访中取得了满意的临床结果。大多数患者髂腰肌力量完全恢复，疼痛轻微或无疼痛，FJS优良，髋臼壁骨块骨整合。
