Malhotra Rajesh, Parameswaran Apurve, Gautam Deepak, Batra Sahil, Apsingi Sunil, Ponnala Vinay K, Eachempati Krishna K
Indraprastha Apollo Hospitals, New Delhi, India.
Medicover Hospitals, Hyderabad, India.
Bone Jt Open. 2025 Jun 1;6(6 Supple B):7-14. doi: 10.1302/2633-1462.66.BJO-2024-0199.R1.
Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiological outcomes and complications of the 'acetabular distraction technique' for the management of CPD during revision hip arthroplasty.
Patients with CPD, who underwent acetabular revision between January 2014 and April 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, preoperative acetabular bone loss, duration of follow-up, clinical and radiological outcomes, and survivorship were evaluated.
In all, 46 patients with a mean follow-up of 34.4 months (24 to 120) were available for evaluation. There were 25 male (54.3%) and 21 female (45.7%) patients, with a mean age of 58.1 years (40 to 81) at the time of revision surgery. Based on the Paprosky classification for acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type IIIB, IIIA, and IIC defects, respectively. All patients were managed using the Trabecular Metal Acetabular Revision System; 16 patients required additional Trabecular Metal augments. The mean Harris Hip Score improved from 50.1 (34.3 to 59.8) preoperatively to 86.6 (74.8 to 91.8) at the last follow-up (p < 0.001). Of the 46 patients studied, 34 were able to walk unaided, whereas 12 required a walking stick. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 patients (78.3%) showed healing of the pelvic discontinuity through bony bridging. The overall cup survivorship was 97.8%, while the three-year survivorship free from any re-revision was 94.1% based on a Kaplan-Meier survival plot.
The acetabular distraction technique results in good clinical and radiological outcomes in the management of CPD during revision hip arthroplasty.
髋关节翻修术中慢性骨盆不连续（CPD）是一个难以处理的问题。本研究的目的是评估“髋臼牵张技术”在髋关节翻修术中处理CPD的临床和影像学结果及并发症。
对2014年1月至2022年4月期间在两个三级医疗中心使用相同牵张技术进行髋臼翻修的CPD患者进行评估。评估人口统计学参数、术前髋臼骨丢失情况、随访时间、临床和影像学结果以及生存率。
共有46例患者可供评估，平均随访时间为34.4个月（24至120个月）。其中男性25例（54.3%），女性21例（45.7%），翻修手术时的平均年龄为58.1岁（40至81岁）。根据髋臼骨丢失的Paprosky分类，分别有19例（41.3%）、12例（26.1%）和15例（32.6%）患者存在IIIB型、IIIA型和IIC型缺损。所有患者均使用小梁金属髋臼翻修系统进行处理；16例患者需要额外的小梁金属增强物。Harris髋关节评分的平均值从术前的50.1（34.3至59.8）提高到最后一次随访时的86.6（74.8至91.8）（p<0.001）。在研究的46例患者中，34例能够独立行走，而12例需要使用拐杖。2例患者（4.3%）出现部分坐骨神经麻痹，2例（4.3%）发生后脱位，1例（2.2%）因无菌性松动需要再次翻修。影像学检查显示，36例患者（78.3%）通过骨桥接实现了骨盆不连续的愈合。根据Kaplan-Meier生存曲线，髋臼杯的总体生存率为97.8%，而三年无再次翻修的生存率为94.1%。
髋臼牵张技术在髋关节翻修术中处理CPD时可取得良好的临床和影像学结果。
