Blum Nicolas, Mesnard Guillaume, Batailler Cécile, Lustig Sébastien
Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France - Orthopaedics and Traumatology, Univ Besançon, UFR Santé, 19 rue Ambroise Paré, 25000 Besançon, France.
Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France.
SICOT J. 2025;11:48. doi: 10.1051/sicotj/2025049. Epub 2025 Aug 26.
Acetabular reconstruction during revision total hip arthroplasty (THA) with major bone loss is a complex surgical challenge. The combination of custom-made (CM) acetabular components with cemented dual mobility (DM) cups may improve postoperative outcomes in this context. This study aims to assess the clinical, functional, and radiological results of this surgical approach.
We conducted a retrospective, single-center observational study including 16 patients (mean age 70 years) who underwent revision THA between May 2016 and December 2024 using a cemented DM cup in a CM acetabular component. All patients presented with Paprosky 3A or 3B defects, and 38% had a history of periprosthetic joint infection (PJI). Functional outcomes were measured using the Oxford Hip Score (OHS) and modified Harris Hip Score (mHHS) pre- and postoperatively. Radiographic assessment included measurement of the center of rotation (COR) deviation in both axes, as well as acetabular inclination and anteversion on postoperative CT scans. Implant survival was analyzed using Kaplan-Meier methodology.
At a mean follow-up of 16.2 months, overall implant survival was 75%, increasing to 93.8% when excluding isolated DM cup revisions. No postoperative infections were observed. OHS improved from 14.1 to 27.6 and mHHS from 27.4 to 52.7 (p < 0.001 for both). A significant negative correlation was observed between vertical (y-axis) COR deviation and functional scores (p < 0.01), highlighting the importance of restoring vertical COR. Mean inclination and anteversion were 41.2° and 29°, respectively, generally within target alignment zones.
The combination of cemented DM cups with CM acetabular components appears to be an effective technique in complex revision THA. Functional recovery and implant survivorship are consistent with the existing literature, and the absence of infection despite prior PJI history suggests benefit from a multidisciplinary approach. Restoration of vertical COR is a predictor of functional outcomes.
在翻修全髋关节置换术（THA）中，髋臼重建伴有严重骨缺损是一项复杂的手术挑战。在这种情况下，定制（CM）髋臼组件与骨水泥双动（DM）髋臼杯相结合可能会改善术后结果。本研究旨在评估这种手术方法的临床、功能和影像学结果。
我们进行了一项回顾性单中心观察性研究，纳入了16例患者（平均年龄70岁），他们在2016年5月至2024年12月期间接受了使用CM髋臼组件中的骨水泥DM髋臼杯的翻修THA。所有患者均表现为Paprosky 3A或3B型骨缺损，38%有假体周围关节感染（PJI）病史。术前和术后使用牛津髋关节评分（OHS）和改良Harris髋关节评分（mHHS）测量功能结果。影像学评估包括测量两个轴向上的旋转中心（COR）偏差，以及术后CT扫描上的髋臼倾斜度和前倾角。使用Kaplan-Meier方法分析植入物存活率。
平均随访16.2个月时，总体植入物存活率为75%，排除单纯DM髋臼杯翻修后升至93.8%。未观察到术后感染。OHS从14.1提高到27.6，mHHS从27.4提高到52.7（两者p<0.001）。在垂直（y轴）COR偏差与功能评分之间观察到显著的负相关（p<0.01），突出了恢复垂直COR的重要性。平均倾斜度和前倾角分别为41.2°和29°，一般在目标对线区内。
骨水泥DM髋臼杯与CM髋臼组件相结合似乎是复杂翻修THA中的一种有效技术。功能恢复和植入物存活率与现有文献一致，尽管有PJI病史但未发生感染表明多学科方法有益。垂直COR的恢复是功能结果的一个预测指标。
