Total hip arthroplasty with monobloc press-fit acetabular components and large-diameter bearings for atypical acetabula is safe: a consecutive case series of 125 hips with mean follow-up of 9 years.

IF 2.2 4区 医学 Q2 SURGERY
Canadian Journal of Surgery Pub Date : 2024-02-06 Print Date: 2024-01-01 DOI:10.1503/cjs.014022
Paul-André Synnott, Marc-Olivier Kiss, Maged Shahin, Mina W Morcos, Benoit Binette, Pascal-André Vendittoli
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引用次数: 0

Abstract

Background: Large-diameter head (LDH) total hip arthroplasty (THA) with a monobloc acetabular component improves hip stability. However, obtaining initial press-fit stability is quite challenging in atypical acetabula. The purpose of this study was to assess primary and secondary fixation of monobloc cups in atypical acetabula.

Methods: In this consecutive case series, the local arthroplasty database was used to retrospectively identify patients with secondary osteoarthritis who underwent primary hip replacement with press-fit only LDH monobloc acetabular components between 2005 and 2018 and who had a minimum of 2 years of follow-up. Radiographic evaluation was performed at last follow-up, and patient-reported outcome measures (PROMs) were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Forgotten Joint Score (FJS), and the Patient's Joint Perception (PJP) question.

Results: One hundred and six LDH THAs and 19 hip resurfacings were included in the study. Preoperative diagnoses included hip dysplasia (36.8%), Legg-Calve-Perthes disease (32.0%), osteoarthritis with acetabular deficiency (17.6%), periacetabular osteotomy (8.0%), arthrodesis (4.0%), and osteopetrosis (1.6%). After a mean follow-up of 9.2 years, no aseptic loosening of the acetabular component was recorded nor observed on radiologic review. There were 13 (10.4%) revisions unrelated to the acetabular component fixation. The mean WOMAC and FJS scores were 9.2 and 80.9, respectively. In response to the PJP question, 49.4% of the patients perceived their hip as natural, 19.1% as an artificial joint with no restriction, 31.5% as an artificial joint with restriction, and none as a non-functional joint.

Conclusion: Primary press-fit fixation of monobloc acetabular components with LDH implanted in atypical acetabula led to secondary fixation in all cases with low revision and complication rates and great functional outcomes. With careful surgical technique and experience, systematic use of supplemental screw fixation is not essential in THA with atypical acetabula.

使用整体压入式髋臼组件和大直径轴承进行全髋关节置换术治疗不典型髋臼是安全的:对 125 例髋关节进行的连续病例系列研究,平均随访 9 年。
背景:使用单体髋臼组件的大直径头(LDH)全髋关节置换术(THA)可提高髋关节的稳定性。然而,在不典型髋臼中获得初始压配稳定性是相当具有挑战性的。本研究旨在评估单体髋臼杯在不典型髋臼中的初次和二次固定情况:在这项连续性病例系列研究中,我们利用当地关节成形术数据库回顾性地识别了在 2005 年至 2018 年期间接受过初次髋关节置换术、仅使用压入式 LDH 单体髋臼组件且随访至少 2 年的继发性骨关节炎患者。最后一次随访时进行了放射学评估,并使用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、遗忘关节评分(FJS)和患者关节感知(PJP)问题评估了患者报告的结果指标(PROMs):研究共纳入了 166 例 LDH THAs 和 19 例髋关节置换术。术前诊断包括髋关节发育不良(36.8%)、Legg-Calve-Perthes 病(32.0%)、骨关节炎伴髋臼缺损(17.6%)、髋臼周围截骨术(8.0%)、关节成形术(4.0%)和骨质增生(1.6%)。经过平均 9.2 年的随访,未发现髋臼组件出现无菌性松动,放射学检查也未发现此类情况。有13例(10.4%)翻修手术与髋臼组件固定无关。WOMAC 和 FJS 平均得分分别为 9.2 分和 80.9 分。在回答PJP问题时,49.4%的患者认为自己的髋关节是自然的,19.1%认为是无限制的人工关节,31.5%认为是有限制的人工关节,没有人认为是无功能的关节:结论:在非典型髋臼中植入LDH单体髋臼组件的初次压入固定术可实现二次固定,所有病例的翻修率和并发症发生率都很低,功能效果也很好。如果手术技巧和经验娴熟,在髋臼不典型的 THA 中系统性地使用辅助螺钉固定并非必要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.00
自引率
8.00%
发文量
120
审稿时长
6-12 weeks
期刊介绍: The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.
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