AlFayyadh Faisal M, Howard Lisa C, Masri Bassam A, Greidanus Nelson V, Garbuz Donald S, Neufeld Michael E
Department of Orthopaedics, University of British Columbia, Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada.
J Arthroplasty. 2025 Sep;40(9S1):S405-S410. doi: 10.1016/j.arth.2025.05.094. Epub 2025 Jun 4.
There remains concern regarding simultaneous constrained liner (CL) implantation during acetabular component revision in revision total hip arthroplasty due to potential fixation loss at the bone-implant interface. There are scarce long-term data on this technique. This study aimed to determine the survivorship free from aseptic cup loosening (fixation failure) and all-cause re-revision when CLs were implanted concurrently with acetabular cup revision.
We retrospectively identified all revision total hip arthroplasties where CLs were implanted simultaneously with acetabular cup revision at our institution between 2001 and 2021. We included 174 revisions with a mean follow-up of 8.7 years (range, 2 to 21.7). The mean age was 70 years, and 60.9% were women. There were 10% that had Paprosky type I bone loss, 68.4% had type IIA-C, and 21.3% had type IIIA-B. The main indications for index acetabular revision were instability (35%), second-stage reimplantation (26.4%), and loosening (17.2%). Only 25% of revisions used modern, highly porous revision shells. There were two-thirds of the CLs manufactured by one implant company and one-third by another. There were 23 (13%) cemented CLs. Screw fixation was evaluated. Kaplan-Meier survival was determined with revision for cup aseptic loosening and all-cause re-revision as endpoints.
There were 32 (18.3%) patients who underwent re-revision at a mean of 2.9 years (range, 0.1 to 14.1). The most common reason for re-revision was instability (14). There were three (1.7%) that required re-revision for acetabular component fixation failure. Acetabular component survival free from re-revision due to fixation failure was 98.9% at 5 years and 98.1% at 10 years. The all-cause re-revision-free survival was 84.9% at 5 years and 79.9% at 10 years.
Implanting CLs during acetabular component revision with stable fixation is safe with a very low risk of cup fixation failure. There were no cup fixation failures in highly porous shells.
在翻修全髋关节置换术中髋臼组件翻修时同时植入受限衬垫（CL），由于骨-植入物界面可能出现固定失败，一直存在担忧。关于该技术的长期数据很少。本研究旨在确定在髋臼杯翻修时同时植入CLs后无菌性杯松动（固定失败）和全因再次翻修的生存率。
我们回顾性确定了2001年至2021年在本机构同时进行CLs植入和髋臼杯翻修的所有翻修全髋关节置换术。我们纳入了174例翻修病例，平均随访8.7年（范围2至21.7年）。平均年龄为70岁，女性占60.9%。10%有Paprosky I型骨缺损，68.4%有IIA-C型，21.3%有IIIA-B型。初次髋臼翻修的主要指征是不稳定（35%）、二期再植入（26.4%）和松动（17.2%）。只有25%的翻修使用了现代的、高度多孔的翻修髋臼杯。三分之二的CLs由一家植入物公司生产，三分之一由另一家公司生产。有23例（13%）使用骨水泥固定的CLs。对螺钉固定进行了评估。以髋臼杯无菌性松动翻修和全因再次翻修为终点，确定Kaplan-Meier生存率。
有32例（18.3%）患者平均在2.9年（范围0.1至14.1年）时接受了再次翻修。再次翻修最常见的原因是不稳定（14例）。有3例（1.7%）因髋臼组件固定失败需要再次翻修。髋臼组件因固定失败未进行再次翻修的生存率在5年时为98.9%，在10年时为98.1%。全因无再次翻修生存率在5年时为84.9%，在10年时为79.9%。
在髋臼组件翻修时稳定固定的情况下植入CLs是安全的，杯固定失败风险非常低。高度多孔髋臼杯未出现杯固定失败。
