Midterm results of uncemented acetabular reconstruction for posttraumatic arthritis secondary to acetabular fracture

At an average of 6.3 years after surgery, we evaluated midterm results of uncemented acetabular reconstruction in 31 hips with posttraumatic arthritis that developed after acetabular fracture. Patients were categorized by previous fracture treatments (open-reduction group and conservative-treatment group) and fracture patterns (simple group and complex group). Surgery duration and blood loss were greater in the open-reduction and complex groups than in the conservative-treatment and simple groups (P < .05). The mean Harris Hip Score increased from 49 before surgery to 89 after surgery. Survival with revision or radiographic acetabular loosening as an end point was 100%. Fracture treatments and patterns were associated with increased surgery duration and increased blood loss. Open reduction and internal fixation of a fracture favor anatomical restoration of the hip's rotational center.     

Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study

Total hip arthroplasty (THA) remains an available surgical option for failed treatment of acetabular fractures. We retrospectively analyzed 53 patients who underwent THA because of failed treatment of acetabular fractures. The mean duration of follow-up monitoring was 64 months (range, 32-123 months) in 49 patients. The average Harris hip score increased from 49.5 before surgery to 90.1 at the latest follow-up examination. Postoperative complications included 1 dislocation, 3 sciatic nerve injuries, and 3 class III instances of heterotopic ossification. There was only 1 revision due to aseptic loosening of the acetabular and femoral component. Despite the technically demanding nature of the procedure, the results of acetabular reconstruction are encouraging in these patients; complication rates are low, and patient satisfaction level is high.     

Midterm results of 506 solid trispiked reflection cementless acetabular components for primary total hip arthroplasty

The purpose of this prospective study was to evaluate the outcomes and survivorship of a trispiked, sintered bead-coated titanium shell with a polished inner surface, no screw holes, and an improved locking mechanism. A total of 506 total hip arthroplasties with a minimum 5-year follow-up were available for review at a mean of 7 years (range, 5-11 years). Three sockets (0.6%) were revised for reasons other than aseptic loosening, and 14 (2.8%) polyethylene liners were exchanged. There was no difference in revision rate between non-cross-linked and highly cross-linked liners (P = .4). There were no cases of radiographic loosening. Retroacetabular osteolysis was identified in 2%. The overall 5-year and 10-year Kaplan-Meier survivorship was 97.5% and 97.4%, respectively, whereas survivorship of the shell was 99.8%.     

A comparison of the outcome of cemented all-polyethylene and cementless metal-backed acetabular sockets in primary total hip arthroplasty

We compared, after a 10-year-minimum follow-up, the outcome of 50 cemented all-polyethylene Charnley acetabular sockets with that of 51 cementless metal-backed sockets in 2 comparable cohorts of young patients. Although the revision rate for the cemented and cementless group was 28% and 35%, respectively, the revision rate for aseptic loosening was 28% for the cemented and 12% for the cementless group. The mean polyethylene wear was 0.112 and 0.114 mm/y, respectively, for the 2 groups. Linear osteolysis was observed in 18 of 50 cemented sockets. Expansile osteolysis presented in 10 of 51 cementless sockets and only in one of the cemented sockets. In conclusion, cementless components had more durable fixation than cemented components. However, they presented more aggressive expansile osteolysis caused by the coexistence of polyethylene and metal debris.     

Early postoperative acetabular discontinuity after total hip arthroplasty

Periprosthetic acetabular fracture is a rare complication after total hip arthroplasty (THA). However, we have treated 2 patients with acute postoperative acetabular discontinuity that occurred 2 and 3 weeks after primary THA. Both fractures were in elderly osteoporotic female patients with minimal trauma and may have developed from unrecognized intraoperative fractures. Pelvic stability was restored with acetabular revision using medial morselized bone grafting and a cemented reconstruction cage. This report demonstrates that early postoperative periprosthetic acetabular discontinuity after THA is a risk in elderly patients with severe osteoporosis and that salvage of acetabular fixation can be achieved with cemented cage reconstruction and medial morselized bone grafting.     

Cementless hemispheric acetabular component for acetabular revision arthroplasty: a 5- to 19-year follow-up study

This study evaluated the 5- to 19-year clinical and radiographic results of cementless acetabular revision. Between 1986 and 1998, 130 hips (125 patients) underwent cementless acetabular revisions. Ten patients were lost to follow-up; 6 patients died. One hundred nine patients (114 hips) were reviewed at a mean follow-up of 8.8 years. The mean Harris hip score improved from 62.1 to 90.7 at final follow-up. Two hips underwent repeat revision. Twenty-two hips developed cavitary osteolysis. Kaplan-Meier survivorship at 121 months was 98.2% with repeat revision for any reason as the end point and 89.5% with repeat revision or radiographic loosening as the end point. Cementless acetabular revision provides favorable clinical and radiographic results, and the initial disease and age may adversely affect the outcomes.     

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.     

全髋关节置换治疗陈旧性髋臼骨折并创伤性关节炎

目的探讨全髋关节置换术治疗陈旧性髋臼骨折并创伤性关节炎的作用。方法回顾分析全髋关节置换术治疗髋臼骨折合并创伤性关节炎17例的手术方法和疗效。结果17例全部随访20个月以上,髋关节功能按Harris评分,平均86.3分(78.2～91分),病者全部能生活自理不需扶拐行走,14例髋部疼痛消失,3例有轻度疼痛。结论全髋关节置换术治疗陈旧性髋臼骨折并创伤关节炎是一种有效的方法。     

髋部骨折内固定术后继发创伤性髋关节骨性融合的全髋关节置换

[目的]探讨采用全髋关节置换术治疗髋关节创伤性骨性融合的临床疗效及异位骨化处理与防治对策。[方法]回顾性分析本院2010年8月~2013年10月采用生物型全髋关节置换治疗髋部复杂性骨折切开复位内固定术后继发创伤性髋关节骨性融合8例患者的临床资料。8例均为男性;年龄(23~49)岁,平均35.8岁。采用股骨颈楔形截骨解除髋关节骨性融合状态,在C型臂X线机透视下定位髋臼旋转中心,髋臼锉进行髋臼研磨后采用合适的髋臼前倾角置入髋臼假体。以髋关节Harris评分评价术前及术后末次随访时的髋关节功能。[结果]术后随访时间15~48个月,平均28.5个月。术前髋关节Harris评分平均(22.7±3.7)分,术后末次随访时Harris评分平均(93.8±5.2)分,差异有统计学意义(t=31.32,P=0.00)。术中未发生骨折及神经、血管损伤等并发症。[结论]全髋关节置换术治疗髋臼骨折术后继发创伤性髋关节骨性融合可获满意近期疗效。采用股骨颈楔形截骨可安全、有效地解除髋关节骨性融合状态。选择适配的生物型人工髋关节假体并以合理的角度安装,最终获得一个稳定的、具有正常解剖位置的人工全髋关节。     

Cementless two-stage exchange arthroplasty for infection after total hip arthroplasty

We retrospectively reviewed all patients at one center with an infected total hip arthroplasty treated with 2-stage revision using cementless components for the second stage and the PROSTALAC articulated spacer at the first stage. Twenty-nine patients were reviewed and followed for at least 2 years postoperatively. An isolated Staphylococcus species was cultured in 76% (22/29) of patients. Three (10.3%) of 29 patients had recurrent infection at the site of the prosthesis. One of the 3 patients ultimately underwent a Girdlestone arthroplasty. Another patient was managed with irrigation and debridement, whereas the final patient was treated with intravenous antibiotics alone. Treatment of infection at the site of a hip arthroplasty with 2-stage revision using cementless components and an articulated spacer yields recurrence rates similar to revisions where at least one of the components at the second stage is fixed with antibiotic-loaded cement.     

Revision total hip arthroplasty without bone graft of high-grade acetabular defects

Mixed results have been reported with bulk and cancellous bone graft to fill defects during acetabular revision arthroplasty. Jumbo cups have been used to maximize host bone contact, and if adequate initial stability can be achieved, this approach may provide a superior long-term outcome. We retrospectively reviewed a consecutive series of 107 acetabular revisions performed using jumbo cups without bone graft. Bone defects were assessed using a validated radiographic classification system that yielded 64 hips with significant bone defects for inclusion. Mean change in American Academy of Orthopaedic Surgeons lower extremity core and pain scores and in Short Form-12 scores showed increases of 22.01, 37.52, and 17.08 points, respectively. Postoperative radiographs consistently demonstrated host bone ingrowth into the jumbo acetabular shells, except for 3 failures. Careful incremental reaming up to a size that optimizes host bone support and contact may eliminate the need for bone graft in most acetabular revision arthroplasties.     

全髋关节置换术治疗髋臼骨折内固定术后继发创伤性髋关节炎的疗效观察

目的:探讨人工全髋关节置换术治疗髋臼骨折术后创伤性关节炎的临床疗效。方法:回顾性分析2010年6月至2014年6月收治的33例(33髋)髋臼骨折术后创伤性关节炎患者资料,男21例,女12例;年龄22~65岁,平均44.6岁。均采用生物型假体行全髋关节置换术治疗。采用Harris评分对患者术前后的髋关节功能进行评分,拍X线片对假体状态进行影像学评估。结果:所有患者获得随访,随访时间7~38个月,平均21.6个月。末次随访时髋关节Harris评分从术前平均(53.6±2.4)分提高至(94.0±3.0)分,差异有统计学意义(t=55.37,P0.05),髋关节功能明显改善。影像学评估显示假体位置良好,无假体松动、关节脱位及明显假体周围骨溶解等并发症。结论:全髋关节置换术是治疗髋臼骨折内固定术后继发创伤性髋关节炎的有效治疗手段,髋臼骨折内固定材料显露困难但不影响假体安放,行全髋置换术可不取出。     

人工全髋关节置换术治疗髋臼骨折术后创伤性关节炎的中远期疗效

目的探讨人工全髋关节置换术(total hip arthroplasty,THA)治疗髋臼骨折术后创伤性关节炎的中远期临床疗效。方法回顾性分析我院2009年7月至2019年5月收治的21例髋臼骨折术后创伤性关节炎病人的临床资料。其中,男14例,女7例;年龄为(42.38±3.42)岁(24～68岁)。后柱和后壁骨折12例,双柱骨折7例,T型骨折2例;合并骨不连3例,骨折畸形愈合6例,异位骨化4例,股骨头半脱位5例,股骨头塌陷3例。骨折初次内固定手术至THA的间隔时间为(27.6±4.5)个月(6～62个月)。收集病人手术前后的髋关节Harris评分,通过X线、CT对假体状态进行影像学评估。结果手术采取改良的Harding入路6例、髋后侧入路15例。术中需完全取出内固定物4例、部分取出10例、未取出7例。使用生物固定型假体18例、骨水泥固定假体3例。骨缺损采用结构性植骨2例,松质骨颗粒植骨13例。术后发生假体周围感染1例,经二期翻修后治愈;并发坐骨神经损伤1例,经治疗半年后恢复。病人随访8个月～10年,平均6.5年。发生异位骨化3例,因无功能影响而未处理;髋关节Harris评分从术前的(...     

Locked inferior fracture dislocation after total hip arthroplasty

Acetabular fracture in conjunction with dislocation after total hip arthroplasty is a rarely reported event. We describe such a case with a unique fracture dislocation pattern, whereby the prosthetic femoral component dislocated inferiorly, fracturing the pelvis, and was locked in this position. The patient was treated with closed reduction under anesthesia and the fracture healed without further surgical intervention. However, she has experienced subsequent instability episodes and we have recommended revision surgery.     

Acetabular micromotion as a measure of initial implant stability in primary hip arthroplasty: An in vitro comparison of different methods of intial acetabular component fixation

Micromotion has been shown to affect bony ingrowth into cementless components. This study was designed both to quantitate initial micromotion at the prosthesis-periacetabular bony interface and to compare different methods of commonly employed acetabular component fixations, ie, a press-fit hemispherical titanium cup, a press-fit hemispherical titanium cup with one and two dome screws, a press-fit titanium hemispherical cup with three spikes, and a cemented chromium-cobalt cup. The press-fit component without screws demonstrated the greatest motion equaling 162 μm at the ilium, 97 μm at the pubis, and 54 μm at the ischium. With one and two screws placed into the dome, the mean ileal displacement decreased by 28 μm (17%) and 36 μm (22%), respectively. Dome screw placement demonstrated a minimal effect at the pubis and ischium. Compared to the press-fit component without augmentation, the tri-spike motion was less at the pubis and ischium. The cemented prosthesis provided the least amount of motion in all three areas tested. This experiment demonstrates that the ilium provides the least amount of support to immediate acetabular fixation, while the pubis (anterior column) and ischium (posterior column) provide more stability. One dome screw does not afect the stability of a hemispherical prosthetic cup significantly. A two dome screw fixation provides an added method of support at the ilium, but fails to decrease motion at the pubis or ischium significantly. The tri-spike fixation does not restrict motion at the ilium to the extent as the dome screws, but its effect at the ischium and pubis is much more pronounced. The obvious difference between initial motion seen with cemented versus uncemented components may suggest that before surgery, patients may need a period of protected weight bearing until ingrowth has occurred.     

Total hip arthroplasty in acetabular fractures

Total Hip Arthroplasty (THA) is a well-accepted treatment for established hip arthritis following acetabular fractures. If a conservatively managed or operated case progresses to non-union/mal-union failing to restore the joint integrity, it may eventually develop secondary arthritis warranting a total hip arthroplasty. Also, in recent years, acute total hip arthroplasty is gaining importance in conditions where the fracture presents with pre-existing hip arthritis, is not amenable to salvage by open reduction and internal fixation, or, a poor prognosis is anticipated following fixation.There are several surgical challenges in performing total hip arthroplasty for acetabular fractures whether acute or delayed. As a separate entity elderly patients pose a distinct challenge due to osteoporosis and need stable fixation for early weight bearing alleviating the risk of any thromboembolic event, pulmonary complications and decubitus ulcer. The aim of surgery is to restore the columns for acetabular component implantation rather than anatomic fixation. Meticulous preoperative planning with radiographs and Computed Tomography (CT) scans, adequate exposure to delineate the fracture pattern, and, availability of an array of all instruments and possible implants as backup are the key points for success. Previous implants if any should be removed only if they are in the way of cup implantation or infected. Press fit uncemented modern porous metal acetabular component with multiple screw options is the preferred implant for majority of cases. However, complex fractures may require major reconstruction with revision THA implants especially when a pelvic discontinuity is present.     

Total hip arthroplasty in acetabular fractures

Total Hip Arthroplasty (THA) is a well-accepted treatment for established hip arthritis following acetabular fractures. If a conservatively managed or operated case progresses to non-union/mal-union failing to restore the joint integrity, it may eventually develop secondary arthritis warranting a total hip arthroplasty. Also, in recent years, acute total hip arthroplasty is gaining importance in conditions where the fracture presents with pre-existing hip arthritis, is not amenable to salvage by open reduction and internal fixation, or, a poor prognosis is anticipated following fixation.There are several surgical challenges in performing total hip arthroplasty for acetabular fractures whether acute or delayed. As a separate entity elderly patients pose a distinct challenge due to osteoporosis and need stable fixation for early weight bearing alleviating the risk of any thromboembolic event, pulmonary complications and decubitus ulcer. The aim of surgery is to restore the columns for acetabular component implantation rather than anatomic fixation. Meticulous preoperative planning with radiographs and Computed Tomography (CT) scans, adequate exposure to delineate the fracture pattern, and, availability of an array of all instruments and possible implants as backup are the key points for success. Previous implants if any should be removed only if they are in the way of cup implantation or infected. Press fit uncemented modern porous metal acetabular component with multiple screw options is the preferred implant for majority of cases. However, complex fractures may require major reconstruction with revision THA implants especially when a pelvic discontinuity is present.     

人工全髋关节置换术治疗化脓性髋关节炎后遗骨关节病的研究进展

目的总结人工全髋关节置换术(total hip arthroplasty,THA)治疗化脓性髋关节炎后遗骨关节病的研究进展。方法广泛查阅国内外近年相关文献,就THA治疗化脓性髋关节炎后遗骨关节病的时机、髋臼侧及股骨侧处理方法以及假体类型选择等方面进行总结分析。结果THA是治疗化脓性髋关节感染后遗骨关节病的有效手段,为避免感染复发,建议感染静止期达10年以上时手术。此类患者可能存在髋臼侧发育不良,髋臼覆盖率差,行THA时可选择高位造臼、髋臼内陷截骨、结构性植骨、Cage、钽金属垫块或3D打印假体等方式处理;股骨侧可能存在股骨髓腔细小、股骨颈前倾角增大、颈干角增大、大转子延长和骨质差等问题,行THA时可通过股骨截骨及选择合适型号假体进行处理。化脓性髋关节炎后遗骨关节病患者多较年轻,为获得更好的远期假体生存率,首选非骨水泥型假体。结论THA可有效治疗化脓性髋关节炎后遗骨关节病,但手术难度大、手术并发症相对较多,术者应有充分认识。     

老年骨盆骨折患者术后行臼底取物+全髋置换1例

患者,女,77岁,曾于20余年前因车祸伤致骨盆多发骨折,于当地医院行切开复位内固定术,2年前无明显诱因下出现右髋部疼痛伴活动不利,于2019年9月5日在山东省中医院门诊就诊。右髋“4”字试验(+);髋关节X线片显示:右髋关节间隙消失,股骨头变扁、塌陷,骨赘形成,骨盆上内固定物寄留,诊断为右股骨头坏死(见图1A)。行髋部CT+三维重建检查:内固定物寄留于臼底,且臼底多处骨缺损,局部骨质疏松。拟行右侧骨盆臼底取物+全髋置换术。