结构异体骨移植在髋臼大面积缺损翻修髋关节置换术中的应用：系统回顾和荟萃分析

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-03 DOI:10.1002/jeo2.70241

Pietro Cimatti, Nicolandrea Del Piccolo, Alessandro Mazzotta, Benedetta Dallari, Enrico Pennello, Dante Dallari

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引用次数: 0

摘要

目的在全髋关节翻修术（rTHA）中处理大量髋臼缺损提出了重大挑战，有一系列可用的技术和正在进行的关于其疗效的讨论。本meta分析旨在评估结构异体移植物联合骨水泥杯、无骨水泥杯或加固装置治疗Paprosky III型和美国骨科学会（AAOS） III - iv型髋臼缺损的失败率。方法利用PubMed/MEDLINE、EMBASE和Cochrane系统评价数据库对1980年1月至2024年4月1日发表的相关研究进行系统评价。检索使用了与髋臼嵌塞植骨、rTHA和相关技术相关的术语。主要观察指标是8年期间内种植体的失败率。结果28项研究符合既定的纳入标准，涵盖三种治疗方法：(1)带骨水泥杯的结构同种异体移植（4项研究），(2)带骨水泥杯的结构同种异体移植（10项研究），(3)带强化装置的结构同种异体移植（21项研究）。总体8年种植失败率为16% (95% CI, 11%-21%)，不同治疗方式间差异显著（p = 0.017）。强化装置的失败率最低（12%），而胶结杯的失败率最高（30%）。失效机制主要为无菌性松动（68.9%），其次为感染（20.3%）和脱位（10.8%）。与无水泥杯和加固装置相比，使用水泥杯的无菌松动率更高（分别为19%对13%和6%）；p = 0.023)。结论：同种异体结构移植物联合加固装置治疗髋臼骨缺损的效果良好，与其他技术相比，失败率明显降低。增加加固装置大大降低了种植体失败的风险。证据等级三级。

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Use of structural bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis

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Use of structural bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis

Purpose

Managing substantial acetabular defects during revision total hip arthroplasty (rTHA) poses significant challenges, with a range of techniques available and ongoing discussions regarding their efficacy. This meta-analysis aimed to assess the failure rates associated with Paprosky type III and American Academy of Orthopaedic Surgeons (AAOS) types III–IV acetabular defects treated with structural allografts in conjunction with cemented cups, cementless cups, or reinforcement devices.

Methods

A systematic review was performed utilising PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews to identify pertinent studies published from January 1980 to 1 April 2024. The search employed terms related to acetabular impaction bone grafting, rTHA, and associated techniques. The main outcome measure was the implant failure rate over an 8-year period.

Results

Twenty-eight studies met the established inclusion criteria, covering three therapeutic approaches: (1) structural allograft with a cemented cup (four studies), (2) structural allograft with a cementless cup (10 studies), and (3) structural allograft with reinforcement devices (21 studies). The overall 8-year implant failure rate was found to be 16% (95% CI, 11%–21%), with significant differences noted among the treatment modalities (p = 0.017). The failure rate was lowest for reinforcement devices (12%) and highest for cemented cups (30%). The predominant failure mechanism was aseptic loosening (68.9%), followed by infection (20.3%) and dislocation (10.8%). Rates of aseptic loosening were greater with cemented cups compared to cementless cups and reinforcement devices (19% vs. 13% and 6%, respectively; p = 0.023).

Conclusions

Structural allografts combined with reinforcement devices yield favourable outcomes for managing large acetabular defects during revision THA, demonstrating significantly lower failure rates compared to other techniques. The addition of reinforcement devices substantially reduces the risk of implant failure.