Objective: To investigate the short- and mid-term effectiveness of revision hip arthroplasty by using impaction bone allograft and acetabular components in treatment of severe acetabular defects.
Methods: A clinical data of 42 patients (44 hips) with severe acetabular defects between February 2011 and May 2018 were retrospectively analyzed. All patients underwent revision hip arthroplasty by using impaction bone allograft and acetabular components. Cemented cup (24 cases, 24 hips) and non-cemented cup (18 cases, 20 hips) were used in the revision surgery. There were 17 males and 25 females with an average age of 62.8 years (range, 22-84 years). The interval between the first total hip arthroplasty and revision was 2.5-12.0 years (mean, 8.3 years). The patients were accepted revision surgery for prosthesis aseptic loosening in 32 hips (31 cases) and the periprosthetic infection in 12 hips (11 cases). Twenty-nine hips (28 cases) were Paprosky type ⅢA and 15 hips (14 cases) were type ⅢB. The preoperative Harris score was 22.25±10.31 and the height of hip rotation center was (3.67±0.63) cm and the length difference of lower limbs was (3.41±0.64) cm.
Results: The operation time was 130-245 minutes (mean, 186 minutes) and the intraoperative blood loss was 600-2 400 mL (mean, 840 mL). The postoperative drainage volume was 250-1 450 mL (mean, 556 mL). Superficial infection of the incision occurred in 1 case, and the incisions healed by first intention in the other patients. All patients were followed up 6-87 months, with an average of 48.6 months. At last follow-up, the Harris score was 85.85±9.31, which was significantly different from the preoperative score ( t=18.563, P=0.000). Imaging examination revealed that the allogeneic bone gradually fused with the host bone, and no obvious bone resorption was observed. At last follow-up, the height of the hip rotation center was (1.01±0.21) cm, which was significantly different from the preoperative level ( t=17.549, P=0.000); the length difference of lower limbs was (0.62±0.51) cm, which was significantly different from the preoperative level ( t=14.211, P=0.000). The Harris score in the cemented group and non-cemented group increased significantly at last follow-up. The height of the hip rotation center decreased, and the hip rotation centers of both groups were within the Ranawat triangle zone. The length difference of the lower limbs also decreased, and the differences in all indexes were significant between pre- and post-operation ( P<0.05). There was significant difference in the height of the hip rotation center between groups ( t=2.095, P=0.042), but there was no significant difference in the Harris score and the length difference of lower limbs between groups ( P>0.05).
Conclusion: For severe acetabular defect (Paprosky type Ⅲ), the hip can be reconstructed with the impaction bone allograft and cemented or non-cemented components in revision hip arthroplsty. The short- and mid-term effectiveness are satisfactory.
目的: 探讨对严重髋臼骨缺损患者采用同种异体颗粒骨打压植骨联合骨水泥型或非骨水泥型假体翻修的早中期疗效。.
方法: 回顾分析 2011 年 2 月—2018 年 5 月采用同种异体颗粒骨打压植骨联合假体翻修治疗的 42 例（44 髋）严重髋臼骨缺损患者临床资料，其中采用骨水泥型臼杯 24 例（24 髋）、非骨水泥型臼杯 18 例（20 髋）。男 17 例，女 25 例；年龄 22～84 岁，平均 62.8 岁。初次人工全髋关节置换术距该次翻修术时间为 2.5～12.0 年，平均 8.3 年。翻修原因：假体无菌性松动 31 例（32 髋），假体周围感染 11 例（12 髋）。按照髋臼骨缺损 Paprosky 分型标准：ⅢA 型 28 例（29 髋），ⅢB 型 14 例（15 髋）。术前髋关节 Harris 评分为（22.25±10.31）分。髋关节旋转中心高度为（3.67±0.63）cm，双下肢长度差值为（3.41±0.64）cm。.
结果: 手术时间为 130～245 min，平均 186 min。术中出血量 600～2 400 mL，平均 840 mL。术后引流量 250～1 450 mL，平均 556 mL。术后 1 例出现切口浅表感染，其余患者切口均Ⅰ期愈合。患者均获随访，随访时间 6～87 个月，平均 48.6 个月。末次随访时 Harris 评分为（85.85±9.31）分，与术前比较差异有统计学意义（ t=18.563， P=0.000）。影像学复查显示同种异体骨与宿主骨逐步融合，未见明显骨吸收。末次随访时，髋关节旋转中心高度为（1.01±0.21）cm，与术前比较差异有统计学意义（ t=17.549， P=0.000）；双下肢长度差值为（0.62±0.51）cm，与术前比较差异有统计学意义（ t=14.211， P=0.000）。与术前相比，末次随访骨水泥组、非骨水泥组 Harris 评分明显提高，髋关节旋转中心高度下降且均在 Ranawat 三角内，双下肢长度差值亦减小，差异均有统计学意义（ P<0.05）；两组髋关节旋转中心高度比较差异有统计学意义（ t=2.095， P=0.042），Harris 评分及双下肢长度差值比较差异无统计学意义（ P>0.05）。.
结论: 对于 Paprosky Ⅲ型髋臼骨缺损患者，根据缺损程度选择同种异体颗粒骨打压植骨联合骨水泥型或非骨水泥型假体翻修，均可有效重建髋关节，并获得较好的早中期疗效。.
Keywords: Hip; acetabular defect; allogeneic bone; impaction bone grafting; joint reconstruction; revison.