Mika Aleksander P, Wilson Jacob M, Christie Michael J, Christie Matthew C, DeBoer David K, Morrison J Craig, Polkowski Gregory G, Martin J Ryan
Vanderbilt University Medical Center, Nashville, Tennessee.
Southern Joint Replacement Institute, Nashville, Tennessee.
J Arthroplasty. 2025 Sep;40(9S1):S411-S417. doi: 10.1016/j.arth.2024.08.040. Epub 2024 Nov 12.
Custom triflange acetabular components (CTACs) can be used to manage patients with severe acetabular bone loss. However, instability remains one of the primary reasons for reoperation and revision for these patients. Primarily constraining these patients is an attractive option to minimize the risk of instability, but theoretically puts more stress on the implant fixation and leads to subsequent failure. Therefore, this study aimed to compare outcomes between patients managed with CTACs with standard liners (SLs) versus those with constrained liners (CLs) at the index procedure.
We identified patients treated with a CTAC for severe acetabular bone loss with a minimum two-year follow-up. Patients received either a CL or SL. Patient demographics and intraoperative details were described, and comparative survival analyses were conducted on all time-to-complication outcomes: years to triflange component failure (aseptic revision and all indications), other revisions of the component exclusive of CTAC, reoperation where no components were exchanged, and dislocation.
There were 37 patients treated with CTAC who received SLs and 44 who received CLs, for a total cohort of 81. The median follow-up time was 4.2 years (interquartile range, 2.6 to 6.7; min/max range, two to 15). Analysis showed no significant survival estimate differences in years to triflange component failure (aseptic revision, P = 0.800, and all indications, P = 0.800), other revisions of the construct exclusive of CTAC (P = 0.500), reoperation where no components were exchanged (P = 0.400), and dislocation (P = 0.500).
Our findings suggest the use of acute CL appears to represent a safe and appropriate option in patients with substantial instability risks without increased risk of component failure compared to SLs over time. Therefore, we recommend consideration of CL in high-risk instability patients requiring CTAC.
定制三翼髋臼组件（CTACs）可用于治疗髋臼严重骨缺损的患者。然而，不稳定仍然是这些患者再次手术和翻修的主要原因之一。对这些患者进行主要约束是降低不稳定风险的一个有吸引力的选择，但理论上会给植入物固定带来更大压力，并导致随后的失败。因此，本研究旨在比较初次手术时使用标准内衬（SLs）的CTACs治疗的患者与使用约束性内衬（CLs）的患者的治疗效果。
我们确定了接受CTAC治疗髋臼严重骨缺损且至少随访两年的患者。患者接受CL或SL。描述了患者的人口统计学和术中细节，并对所有并发症发生时间的结果进行了比较生存分析：三翼组件失败（无菌翻修和所有指征）的年数、不包括CTAC的组件的其他翻修、未更换组件的再次手术以及脱位。
共有81例患者接受了CTAC治疗，其中37例接受了SLs，44例接受了CLs。中位随访时间为4.2年（四分位间距为2.6至6.7年；最小/最大范围为2至15年）。分析显示，在三翼组件失败的年数（无菌翻修，P = 0.800；所有指征，P = 0.800）、不包括CTAC的结构的其他翻修（P = 0.500）、未更换组件的再次手术（P = 0.400）和脱位（P = 0.500）方面，生存估计无显著差异。
我们的研究结果表明，与SLs相比，对于存在严重不稳定风险的患者，使用急性CL似乎是一种安全且合适的选择，且随着时间推移组件失败风险不会增加。因此，我们建议在需要CTAC的高风险不稳定患者中考虑使用CL。
