Bank bone grafts in revision hip arthroplasty for acetabular protrusion

In 23 revision hip arthroplasties in which acetabular protrusion was encountered, homologous bone grafting was used to reconstruct or reinforce the medial wall of the acetabulum. Loosening of the acetabular component was the cause of the protrusion in all the cases. Postoperative follow-up showed a solid bone socket around the acetabular cup in all the cases and no signs of loosening at 3-years' follow-up.     

Bone grafting in total hip replacement for acetabular protrusion: A review of 11 operations

In 11 total hip replacement operations performed on nine patients with acetabular protrusion, the deficient acetabulum was reinforced with a bone graft from the femoral head in ten operations and in one from the greater trochanter and the femoral medullary canal. Acetabular meshes were used in two operations and a fine wire mesh in one.

At follow-up, averaging 18 (8-28) months postoperatively, a solid bone socket for the acetabular component had formed in all hips without evidence of loosening or infection.     

Bone grafting in total hip replacement for acetabular protrusion. A review of 11 operations

In 11 total hip replacement operations performed on nine patients with acetabular protrusion, the deficient acetabulum was reinforced with a bone graft from the femoral head in ten operations and in one from the greater trochanter and the femoral medullary canal. Acetabular meshes were used in two operations and a fine wire mesh in one. At follow-up, averaging 18 (8-28) months postoperatively, a solid bone socket for the acetabular component had formed in all hips without evidence of loosening or infection.     

髋臼加强杯在髋臼翻修术中的应用

目的 观察髋臼加强杯在髋臼翻修手术中巨大髋臼骨缺损修复中的应用疗效.方法 2003年2月至2008年10月对12例在翻修术中存在严重髋臼骨缺损的患者采用植骨与髋臼加强杯重建髋臼骨缺损后固定假体.手术前、后情况进行临床评估及影像学评估.术前骨缺损分类按Paprosky分型:ⅡB型2例,ⅢA型6例,ⅢB型4例.术前Harris评分平均为35.2分.结果 术后所有患者均获随访,平均随访时间37个月(9～71个月);术后第一次随访时Harris评分平均为80.9分,末次随访时平均84.6分.术后假体无松动或断裂.有1例患者翻修术后6个月于髋臼Delee&Chamley Ⅲ区出现轻度放射线透亮带,但继续随访未进展.未出现假体失败而需要再次翻修病例.结论 采用髋臼加强杯联合植骨技术可有效修复髋臼骨缺损,重建髋臼结构稳定性,中短期随访疗效可靠.     

Acetabular reinforcement rings and bone allografts in the reconstructive treatment of periprosthetic bone loss

Medium-term results in the treatment of acetabular bone loss using bulk and/or morselized bone allografts supported by acetabular reinforcement rings are reported. A total of 164 hips in 157 patients were treated by means of this reconstruction technique. The devices employed were Müller ARRR in 24 cases and Burch-Schneider APC in 140. Mean follow-up was 67 months (minimum 12, maximum 123). A total of 4 patients developed deep infection that was treated by resection-arthroplasty. Aseptic loosening of acetabular implant following extensive resorption of bone graft was observed in 5 cases: 3 of the cases underwent acetabular revision. Clinical results were evaluated based on the Harris Hip Score: mean values of 35 and 78 were assessed preoperatively and at follow-up, respectively. X-ray signs of incorporation of bone graft were observed in all cases that progressed successfully.     

应用非骨水泥髋臼或金属髋臼支架行髋关节翻修术的临床研究

目的 评估非骨水泥髋臼及金属髋臼支架加植骨修复髋臼骨缺损的效果.方法 我院自2001年9月至2008年9月应用髋臼翻修支架行髋关节翻修术22例(24髋).其中Lima非骨水泥人工翻修髋臼2例(2髋),Kerboull 支架2例(2髋),GAP 髋臼翻修支架18例(20髋).男性6例(6髋),女性16例(18髋).平均年龄62岁(34～79岁).感染性松动2例(2髋),无菌松动20例(22髋).平均随访时间48个月(18～84个月),对其进行临床和影像学评估.Harris评分术前平均为56分(44～75分).结果 末次随访时22例患者Harris评分平均为89分(78～94分).优良率为95.5%(21/22).三种髋臼翻修支架的外展角满意,髋臼旋转中心基本得到了重建.髋臼翻修支架及其聚氯乙烯臼无明显移位,假体周围无透亮线,髋臼植骨愈合良好.结论 应用非骨水泥髋臼或髋臼支架修复髋臼侧巨大骨缺损,重建了髋臼正常旋转中心、提供了翻修假体的初期稳定性、避免了所植骨在血管化时期的过度机械负重,是翻修髋臼巨大骨缺损的可靠方法.     

颗粒骨打压植骨结合多孔非骨水泥臼杯在AAOSⅢ型髋臼大面积骨缺损翻修中的应用

背景：颗粒骨打压植骨是修复髋臼骨缺损的重要方法,对大面积髋臼骨缺损采用打压植骨结合非骨水泥臼杯重建仍然存在争议。目的：探讨同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损的方法及近期疗效。方法：随访2005年6月至2010年4月收治的28例（28髋）AA0SⅢ型髋臼大面积骨缺损患者。男18例,女10例,年龄34-74岁,平均53．8岁。髋关节置换术后感染醐翻修9例,骨溶解及髋臼假体松动翻修19例。本组AAOSⅢ型髋臼骨缺损面积大,术中见髋臼骨缺损超过髋臼关节面的50％。全部采用同种异体颗粒骨打压植骨结合多孔非骨水泥臼杯髋臼重建术。术后定期随访,观察臼杯有无松动、植入骨与宿主骨整合情况,髋关节功能评分采用Harris评分。结果：28例均获得随访,术后随访时间为13-70个月,平均43个月。Harris评分由术前32-48分,平均41分,提高至末次随访时86-95分,平均90分。28例髋臼假体均固定牢固无松动征象,植入骨逐渐与宿主骨整合,无感染及坐骨神经损伤。结论：在获得臼杯初始稳定固定的情况下,大面积颗粒骨打压植骨（臼杯与宿主骨接触面积〈50％）结合多孔非骨水泥臼杯髋臼重建术修复AAOSⅢ型髋臼大面积骨缺损近期疗效较好,远期疗效尚待进一步随访。     

Acetabular protrusion in thalassemia. A report of four cases

Four female patients with thalassemia intermedia developed secondary acetabular protrusion. These cases could be the first reported cases of nontraumatic acetabular protrusion in patients with thalassemia. The rarified pelvic bone may be due to medullary hyperplasia, iron overload, or disordered calcium metabolism in conjunction with osteomalacia. The fact that currently patients with beta-thalassemia have a longer life expectancy may explain the recent observation of this entity, which should become more familiar to orthopedic surgeons who treat thalassemia patients in the future.     

Intrapelvic migration of the prosthetic acetabular component

The authors propose a preoperative evaluation protocol for cases of dislocation of the prosthetic cup complicated by intrapelvic migration, obtained by studying 20 cases of prosthetic loosening with protrusion of the acetabular component in the pelvis, treated by reimplantation or explantation. In all of the patients, accurate preoperative planning was carried out, because of the considerable frequency of dislocation, compression or damage to the vascular and nervous structures deriving from migration inside the pelvis of the acetabular component. The authors suggest that in all cases of acetabular loosening evaluation involve standard X-rays, bone scan with technethium99 and with marked granulocytes, CT scan. When the cup protrudes in the pelvis, prior to surgery, CT scan with contrast medium will be required, and if the risk of vascular involvement exists, angiography should also be carried out.     

Acetabular revision using acetabular roof reinforcement ring with a hook

This study evaluated the clinical and radiographic results of 37 acetabular revisions using an acetabular roof reinforcement ring with a hook (ARRRH). The average age of the patients was 52.4 years, and the mean follow-up period was 4.5 years. The mean Harris hip score had improved from 49 points preoperatively to 87 points at the final follow-up. The bone graft was radiographically incorporated in all cases. The postoperative complications were a hip dislocation in 3 cases, nonunion of the greater trochanter in 1, infection in 1, discomfort at the autograft donor site in 3, and 2 cases of hook failure. An ARRRH combined with a morsellized bone graft is a useful treatment particularly in moderate-to-severe acetabular bone deficiencies.     

Construction of acetabular bone stock. A staged cementless arthroplasty of the hip

Vascularized pedicular bone graft was used for the purpose of achieving a sufficient bone stock for cementless total hip arthroplasty in patients with major acetabular bone defects. A useful bed for the acetabular prosthesis was obtained in all three cases. The ordinary prosthetic arthroplasty was performed in the second phase. The vitality of the grafted bone was then controlled. The results after a follow-up time of 23, 32 and 40 months respectively are good.     

全髋关节置换术治疗Crowe Ⅳ型髋关节发育不良患者及围手术期并发症分析

目的:探讨人工全髋关节置换术治疗Crowe Ⅳ型成人髋关节发育不良的疗效及围手术期并发症。方法:2000年3月至2010年3月,对19例(23髋)Crowe Ⅳ型成人髋关节发育不良患者进行人工全髋关节置换术,其中男5例,女14例;年龄41～72岁,平均61.3岁。髋臼侧采用小臼杯结合髋臼内陷技术安置臼杯假体,股骨侧采用粗隆下短缩截骨放置股骨假体。采用Harris评分评价术后髋关节功能。结果:所有患者获随访,时间1～8年,平均4.2年,术后X线片显示髋臼假体均位于真臼内,无髋臼假体松动。股骨侧截骨处均骨性愈合。Harris评分由术前平均(34.0±6.9)分提高至末次随访的(85.0±7.5)分。发生围手术期并发症11例,包括股骨劈裂骨折3例,神经并发症3例,截骨延迟愈合2例,术后脱位3例。结论:采用小臼杯、假体内陷技术、股骨短缩截骨对Crowe Ⅳ型DDH患者行全髋关节置换可以重建关节功能,恢复下肢长度,早期疗效满意,但并发症发生率高。后期疗效有待进一步观察。     

骨保留型股骨柄假体在全髋关节置换术中的临床应用

目的 :探讨生物型全髋关节置换术采用Tri-Lock骨保留型股骨柄体在伴有股骨头颈短缩的髋臼内陷中的手术技巧和临床疗效。方法:2013年1月至2015年12月采用全髋关节置换术治疗10例(12髋)的髋臼内陷症患者,男5例(6髋),女5例(6髋);年龄42.5~67.5(51.6±3.0)岁。髋臼全部采用生物型假体陶瓷内衬,股骨头采用全陶瓷头。手术均采用后外侧切口,术后每年随访1次,置换术后行X线片检查评估假体柄位置,Harris评分评估髋关节功能。结果:10例患者术后获随访,时间8~48(33.0±3.5)个月。术中、术后无血管、神经损伤及骨折并发症发生。10例(12髋)术后均立即实现了髋臼及股骨柄的生物性压配。术后3个月X线片上均获广泛性骨长入,均可达到骨性固定,无松动和再次内陷发生。髋关节活动范围由术前(45.8±7.5)°增加至末次随访时的(90.0±6.5)°,其中屈曲增加至(89.0±6.0)°,外展增加至(35.5±7.3)°,内旋增加至(31.8±6.6)°,外旋增加至(32.6±5.2)°。Harris髋关节评分由术前45.7±7.5改善至末次随访91.5±8.5(t=144.832,P0.05)。结论:结合髋臼处理方法,Tri-Lock骨保留型股骨柄体在治疗伴有股骨头颈短缩的髋臼内陷症多合并严重髋关节周围软组织挛缩的患者中,可得到良好压配和保留更多骨质,术中需精细进行髋臼重建和软组织分层松解,术后中短期随访效果安全、满意。     

Acetabular supporting ring in total hip replacement

A series of 14 total hip arthroplasties with a Müller acetabular supporting ring including 3 primary and 11 revision arthroplasties is reviewed. This device was used in cases of acetabular bone deficiency, and bone raft was added in 11 cases. The mean length of follow-up was 39.9 months. Twelve patients had good or satisfactory results, while two operations failed. These results indicate that the acetabular supporting ring is a useful implant in cases with acetabular bone stock deficiency.     

Total hip replacement with spongious bone graft for acetabular protrusion in patients with rheumatoid arthritis

Total hip replacement (THR) with the use of autogenous spongious bone graft reinforcement to the medial acetabular wall proved a successful surgical procedure in patients with rheumatoid arthritis and acetabular protrusion.

In 25/26 THR followed for an average of 2 (1-4) years, the bone grafts healed in place radiographically and no further protrusion occurred. A non-progressive radiolucent zone of 3 mm at the bone-cement interface occurred around one acetabular cup. Recurrent dislocations occurred in one hip, which eventually turned out to have a loose acetabular cup. One hip with a firmly seated cup was converted to a resection arthroplasty 4 months after the primary operation because of deep infection.     

Total hip replacement with spongious bone graft for acetabular protrusion in patients with rheumatoid arthritis

Total hip replacement (THR) with the use of autogenous spongious bone graft reinforcement to the medial acetabular wall proved a successful surgical procedure in patients with rheumatoid arthritis and acetabular protrusion.

In 25/26 THR followed for an average of 2 (1–4) years, the bone grafts healed in place radiographically and no further protrusion occurred. A non-progressive radiolucent zone of 3 mm at the bone-cement interface occurred around one acetabular cup. Recurrent dislocations occurred in one hip, which eventually turned out to have a loose acetabular cup. One hip with a firmly seated cup was converted to a resection arthroplasty 4 months after the primary operation because of deep infection.     

Zweymuller螺旋臼假体治疗类风湿关节炎股骨头中心性脱位的临床研究

目的探讨使用Zweymuller螺旋臼假体治疗类风湿关节炎（RA）髋臼骨缺损中股骨头中心性脱位的临床疗效。方法 自2004年6月至2009年10月,26例（27髋）RA髋臼中心性脱位患者,其中男3例（4髋）,女23例（23髋）,平均年龄52岁（37～62岁）,使用螺旋臼治疗,术中有4例行髋臼底部植骨。结果 平均随访6个月～6年3个月,术前Harris评分30.5分,术后平均84分,术后均未发现假体松动,1例出现假体早期感染,予以抗生素治疗6周后好转。结论 RA股骨头中心性脱位使用Zweymuller螺旋臼治疗,可以或不需在臼底植骨,中期稳定性良好。     

颗粒松质骨压紧植骨全髋关节置换术治疗创伤性髋关节炎的疗效

目的探讨颗粒松质骨压紧植骨全髋关节置换术(THA)治疗髋臼骨折继发创伤性髋关节炎的疗效。方法1998年12月-2005年5月,对15例髋臼骨折继发创伤性髋关节炎患者行颗粒松质骨压紧植骨THA,所有患者髋臼假体均采用骨水泥固定,颗粒骨均取自体骨,术后24h后开始被动活动,3个月后开始全负重锻炼。临床随访采用Harris髋关节评分(HSS)系统评分,对任何原因引起髋臼假体翻修均视为临床失败。根据Conn等影像学评价法观察颗粒骨长人情况,根据DeLee的三区法测量臼杯、骨水泥与移植骨间的界面宽度,臼杯的移位程度则依据其相对于泪点间线的距离而定。结果14例患者获得平均4．3年(1．0-7．5年)随访,HHS评分由术前平均42分(10-62分)提高到随访结束时平均84分(58-98分)。1例髋部有轻度疼痛,无患者行翻修手术。大部分髋部恢复了其正常的旋转中心,仅有2例高出对侧0．8 mm。大多数患者影像学表现稳定,2例在Ⅰ区和Ⅲ区出现进行性增宽的透亮带,1例在Ⅲ区出现非进行性增宽的透亮带。1例臼杯假体在术后7年出现明显移位(6 mm),但并没有行翻修手术。结论颗粒骨压紧植骨技术作为一种生物学髋臼重建方法,其联合THA治疗髋臼骨折后继发创伤性关节炎伴髋臼缺损的疗效令人满意,能够恢复髋关节的正常解剖和功能活动。     

Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures.
Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised.
Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.     

Use of the Charnley mini-offset bore acetabular component in severe acetabular dysplasia. A preliminary report

Nine total hip arthroplasties were performed in seven patients using the Charnley mini-offset bore acetabular component to assess its effectiveness in cases of severe deficiency of acetabular bone "stock." Preoperative diagnoses included seven chronically dislocated hips and two previously failed arthroplasties. The follow-up period averaged 49 months. Pain relief was dramatic in all patients, and all had increased ambulatory capacity after operation. No clinical loosenings or deep infections were encountered. The small outside diameter (36 mm) of this acetabular component requires only minimal bone removal from the acetabular bed. Its eccentrically positioned bore allows for adequate polyethylene thickness in the weight-bearing area. It also takes advantage of the low frictional torque of a small femoral head system.