背景:全髋关节置换术(THA)的全球性能不断提高,导致了翻修手术的相应增加,主要是由于杯植入失败,无菌性松动和假体周围感染是常见原因。各种技术和植入物,包括巨型杯(JCs),被用来管理去除杯子后的残余骨丢失,促进表面积增加,以改善宿主骨接触和生物骨整合。本研究的目的是通过报告总生存期来确定使用JC植入物的髋臼翻修术在20年随访期间的结果。导致重新翻修手术的并发症,和手术策略在重新修订的情况下。
方法:进行了一项基于大型区域注册的队列研究,在2000年至2020年期间利用JC检查修订的THA手术。该研究包括使用无骨水泥JC进行的所有修正髋臼手术,女性直径≥62毫米,男性直径≥66毫米。排除所有髂固定杯。人口统计数据,修正手术适应症,组件,固定类型,失败的原因,收集和分析再干预策略。对2000年1月至2020年12月期间植入的541例JCs进行了评估。最常见的修正指征是“杯无菌性松动”(54.5%)和“完全无菌性松动”,其中包括杯子和茎(32%)。
结果:巨型杯5年生存率为92.5%,10年85.8%,15年为81.5%。在70次失败中,主要原因是“杯无菌性松动”(40%),“总无菌性松动”(17.1%),和“败血症松动”(12.8%)。修正主要涉及髋臼杯修正手术(54例),成分外植术(11例),或插入/头部修订(5例)。
结论:这项基于注册的JC在修订THA中的研究显示了优异的15年生存率和可接受的失败率。它支持JCs作为一个可行的选择,提供相对简单的手术相比,如抗突起笼的替代品,植骨,和增强。
BACKGROUND: The increasing global performance of total hip arthroplasty (THA) has led to a corresponding rise in revision surgeries, primarily due to cup implant failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), are employed to manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact and biological osteointegration. The purpose of the present study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survival, complications leading to re-revision surgery, and surgical strategy in the case of re-revision.
METHODS: A cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 mm in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were \"cup aseptic loosening\" (54.5%) and \"total aseptic loosening,\" which included both the cup and stem (32%).
RESULTS: Jumbo cup survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were \"cup aseptic loosening\" (40%), \"total aseptic loosening\" (17.1%), and \"septic loosening\" (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert/head revision (5 cases).
CONCLUSIONS: This registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like anti-protrusion cages, bone grafts, and augments.