背景:在大量髋臼骨丢失的情况下进行髋臼重建具有挑战性。由于髋臼周围的骨量不足,在这些情况下实现植入物稳定性需要特别考虑。杯笼构造是解决该问题的治疗选项。这项研究评估了幸存者,并发症,和使用杯笼结构的功能结果。
方法:从我们对2003年1月至2022年1月的全髋关节置换术的回顾性回顾中确定了总共131个杯笼植入物(129例患者)。在这些案例中,100人(76.3%)是女性,手术时的平均年龄为68岁(范围,29至92;SD[标准偏差],12.4),平均随访时间为7.7年(范围,0.02至20.3;SD,5.1).进行Kaplan-Meier生存分析,失败定义为翻修手术和/或杯笼重建失败。
结果:平均随访7.7年,由于全因失败导致的杯笼结构存活率在5年为83.9%(95%CI[置信区间]:77.6至90.2),88个臀部处于危险之中,74.8%(95%CI:66.2至83.4),10年有38个臀部的风险,和69.8%(95%CI:59.4至80.2)在15年有11个臀部的风险。无菌性松动失败导致的生存率在5年为96.7%(95%CI:93.6~99.8),88髋处于危险中,在10年和15年为95.5%(95%CI:91.6~99.4),38髋和11髋处于危险中。分别。杯和/或保持架无菌性松动的修订率,感染,位错,股骨柄无菌性松动为131例(3.8%)中的5例,131人中的12人(9.1%),131人中的10人(7.6%),和131人中的2人(1.5%)。平均腿长差异(LLD)从12.2mm改善到3.9mm(P<0.001)。
结论:杯笼结构是治疗各种髋臼缺损的可靠治疗选择。有良好的生存能力,临床,和放射学结果,并发症发生率令人满意。
BACKGROUND: Acetabular reconstruction in the context of massive acetabular bone loss is challenging. Achieving implant stability in these situations requires special considerations. The cup-cage construct is a treatment option that addresses this issue. This study evaluates survivorship, complications, and functional outcomes using the cup-cage construct.
METHODS: A total of 131 cup-cage implants (129 patients) were identified from our retrospective review of revision total hip arthroplasties from January 2003 to January 2022. Among these cases, 100 (76.3%) were women, the mean age at the time of surgery was 68 years (range, 29 to 92; SD [SD], 12.4), and the mean follow-up was 7.7 years (range, 0.02 to 20.3; SD, 5.1). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery and/or failure of the cup-cage reconstruction.
RESULTS: At a mean follow-up of 7.7 years, the cup-cage construct survivorship due to all-cause failure was 83.9% (95% CI [confidence interval]: 77.6 to 90.2) at 5 years with 88 hips at risk, 74.8% (95% CI: 66.2 to 83.4) at 10 years with 38 hips at risk, and 69.8% (95% CI: 59.4 to 80.2) at 15 years with 11 hips at risk. The survivorship due to failure from aseptic loosening was 96.7% (95% CI: 93.6 to 99.8) at 5 years with 88 hips at risk and 95.5% (95% CI: 91.6 to 99.4) at 10 and 15 years with 38 and 11 hips at risk, respectively. The revision rate for aseptic loosening of the cup and/or cage, infection, dislocation, and aseptic loosening of the femoral stem was 5 of 131 (3.8%), 12 of 131 (9.1%), 10 of 131 (7.6%), and 2 of 131 (1.5%).
CONCLUSIONS: The cup-cage construct is a reliable treatment option for the treatment of various acetabular defects. There are favorable survivorship, clinical, and radiographic outcomes, with a satisfactory complication rate.