Tikhilov Rashid M, Volykhin Rodion D, Bilyk Stanislav S, Kovalenko Anton N, Dzhavadov Alisagib A, Shubnyakov Igor I
Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation.
Bone Jt Open. 2025 May 1;6(5 Supple A):41-50. doi: 10.1302/2633-1462.65.BJO-2024-0255.R1.
Despite good results of using uncemented press-fit cups in patients with high hip dislocations (type C as per the Hartofilakidis classification), there are reports of loosening of these components. To improve the results on the acetabular side in patients with high hip dislocations, we used custom-made acetabular implants (CMAIs). The aim of this study was to evaluate the outcomes after total hip arthroplasty (THA) using CMAIs in patients with high hip dislocation.
We retrospectively analyzed the results of primary THA using the CMAIs in 58 hips (52 patients) from November 2017 to December 2019. All surgeries were performed using the femoral shortening osteotomy technique described by Paavilainen. Type C1 and C2 dislocations were observed in nine and 49 hips, respectively. The presence of various complications, functional results using the Oxford Hip Score (OHS), patient satisfaction, radiological parameters, and positioning of CMAIs were assessed.
The mean follow-up period, including radiological follow-up for all 58 hips, was 5.2 years (4.2 to 6.3; SD 0.71). Patients demonstrated statistically significant improved functional outcomes according to the OHS (preoperatively 16.9 and postoperatively 38.5; p < 0.001). Four hips were revised: two hips due to dislocations, the cause of which was impingement of the greater trochanter due to malposition of the distally advanced greater trochanter after osteotomy. One hip was due to nonunion of the distally advanced greater trochanter after osteotomy, and one hip due to pain resulting from iliopsoas impingement caused by contact of the CMAI flange with the iliopsoas muscle. There were no radiological signs of loosening of the CMAIs. Any deviation of the CMAIs from the planned position was noted.
This preliminary study demonstrated that CMAIs may offer good bone fixation in patients with high hip dislocation; however, further biomechanical studies are needed to evaluate the use of CMAIs in terms of osseointegration, additional screw fixation, and to determine the effect of deviation of CMAIs from the planned position on clinically relevant complications.
尽管在高位髋关节脱位患者（根据Hartofilakidis分类为C型）中使用非骨水泥压配型髋臼杯取得了良好效果，但仍有这些部件松动的报道。为了改善高位髋关节脱位患者髋臼侧的治疗效果，我们使用了定制髋臼植入物（CMAIs）。本研究的目的是评估在高位髋关节脱位患者中使用CMAIs进行全髋关节置换术（THA）后的疗效。
我们回顾性分析了2017年11月至2019年12月期间58例髋关节（52例患者）使用CMAIs进行初次THA的结果。所有手术均采用Paavilainen描述的股骨缩短截骨技术。分别在9例和49例髋关节中观察到C1型和C2型脱位。评估了各种并发症的发生情况、使用牛津髋关节评分（OHS）的功能结果、患者满意度、放射学参数以及CMAIs的定位情况。
平均随访期，包括对所有58例髋关节的放射学随访，为5.2年（4.2至6.3年；标准差0.71）。根据OHS，患者的功能结果有统计学意义的改善（术前16.9，术后38.5；p<0.001）。4例髋关节进行了翻修：2例因脱位，原因是截骨术后远端推进的大转子位置不当导致大转子撞击；1例因截骨术后远端推进的大转子不愈合；1例因CMAI凸缘与髂腰肌接触导致髂腰肌撞击引起疼痛。没有CMAIs松动的放射学迹象。记录了CMAIs与计划位置的任何偏差。
这项初步研究表明，CMAIs在高位髋关节脱位患者中可能提供良好的骨固定；然而，需要进一步的生物力学研究来评估CMAIs在骨整合、额外螺钉固定方面的应用，并确定CMAIs与计划位置的偏差对临床相关并发症的影响。
