RECONSTRUCTION MODE SELECTION OF ACETABULAR BONE DEFECT AND EFFECT ON ACETABULAR CUP POSITION IN CEMENTLESS TOTAL HIP ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAOLinhu ^1,2 ,  TANLun ² , LINXu ² , WUChao ² , ZENGJun ²

1. Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;
2. Department of Orthopedics, the Affiliated Zigong Hospital of Luzhou Medical College (the 4th People's Hospital of Zigong City;

Corresponding author：

TANLun, Email: 1098726536@qq.com

Keywords：

Total hip arthroplasty; Bone defect; Acetabular reconstruction; Rotation center

DOI：

10.7507/1002-1892.20150150

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Objective To investigate the reconstruction mode selection of acetabular bone defect and the effect on the acetabular cup position in cementless total hip arthroplasty (THA). Methods A retrospective analysis was made on the clinical data of 78 patients (78 hips) with acetabular bone defect according to the selection criteria who underwent THA between February 2008 and February 2014. In 39 cases having acetabular posterosuperior bone defect with defect area less than 30%, impaction bone grafting was performed (group A); in 24 cases having acetabular posterosuperior bone defect with defect area of 30%-50%, structural bone or tantalum block grafting was performed (group B); in 10 cases having acetabular medial wall bone defect with defect area less than 30%, impaction bone grafting was performed (group C); and in 5 cases having acetabular medial wall bone defect with defect area of 30%-50%, titanium mesh combined with impaction bone grafting was performed (group D). There was no significant difference in gender, age, and side between groups A and B, and between groups C and D (P>0.05). The acetabular abduction angle, anteversion, the horizontal and vertical distances of actual and true rotation center after operation were compared. Results The patients were followed up 7-25 months. Prosthesis loosening occurred in 2 cases of group A, sciatic nerve injury and hip joint dislocation in 1 case of group B, respectively. At immediate after operation and last follow-up, there was no significant differences in the horizontal or vertical distance of actual and the true rotation center between groups A and B (P>0.05); significant difference was found in the horizontal distance between groups C and D (P<0.05), but no significant difference in the vertical distance (P>0.05). Difference was statistically significant in the acetabular abduction angle and anteversion between groups A and B (P<0.05), but difference was not significant between groups C and D (P>0.05). Conclusion In patients with acetabular posterosuperior bone defect, reconstruction methods will have effect on acetabular abduction and anteversion; early acetabulum prosthesis loosening may be associated with too large acetabular abduction angle and inappropriate reconstruction methods. In patients with acetabular medial wall bone defect, the vertical distances of rotation center will shift upward in varying degrees, and reconstruction methods have effect on the horizontal distances of rotation center.

Citation： CAOLinhu, TANLun, LINXu, WUChao, ZENGJun. RECONSTRUCTION MODE SELECTION OF ACETABULAR BONE DEFECT AND EFFECT ON ACETABULAR CUP POSITION IN CEMENTLESS TOTAL HIP ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 693-699. doi: 10.7507/1002-1892.20150150 Copy

1.	Brooks PJ. Dislocation following total hip replacement:causes and cures. Bone Joint J, 2013, 95-B(11 Suppl A):67-69.
2.	Patel SR, Toms AP, Rehman JM, et al. A reliability study of measurement tools available on standard picture archiving and communication system workstations for the evaluation of hip radiographs following arthroplasty. J Bone Joint Surg (Am), 2011, 93(18):1712-1719.
3.	Bosker BH, Verheyen CC, Horstmann WG, et al. Poor accuracy of freehand cup positioning during total hip arthroplasty. Arch Orthop Trauma Surg, 2007, 127(5):375-379.
4.	曹林虎, 谭伦, 吴超, 等. 人工全髋关节置换术中改良髋臼中心化技术对双下肢不等长的影响. 中国修复重建外科杂志, 2014, 28(2):213-217.
5.	Pagnano W, Hanssen AD, Lewallen DG, et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(7):1004-1014.
6.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2):217-220.
7.	康鹏德, 沈彬, 裴福兴. 髋关节翻修术中髋臼骨缺损的评估与重建. 中华骨科杂志, 2013, 33(12):1258-1264.
8.	刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6):643-645.
9.	李栋梁, 李佛保, 朱琦, 等. 人工全髋关节置换术中自体骨重建髋臼骨缺损的临床研究. 中华关节外科杂志(电子版), 2012, 6(1):39-43.
10.	Barrack RL, Newland CC. Uncemented total hip arthroplasty with superior acetabular deficiency. Femoral head autograft technique and early clinical results. J Arthroplasty, 1990, 5(2):159-167.
11.	Jeon DG, Kim MS, Cho WH, et al. Reconstruction with pasteurized autograft-total hip prosthesis composite for periacetabular tumors. J Surg Oncol, 2007, 96(6):493-502.
12.	裴福兴. 关节外科手术操作与技巧. 北京:人民卫生出版社, 2008:290-291.
13.	李雄峰, 管国华, 李建有. 髋关节发育不良人工全髋关节置换术中髋臼中心重建. 中国修复重建外科杂志, 2012, 26(9):1037-1040.
14.	Ybinger T, Kumpan W. Enhanced acetabular component positioning through computer-assisted navigation. Int Orthop, 2007, 31 Suppl 1:S₃5-38.
15.	Merle C, Grammatopoulos G, Waldstein W, et al. Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis. J Bone Joint Surg (Am), 2013, 95(22):e172.
16.	李军伟, 杨广辉, 王义生, 等. 髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值. 中华骨科杂志, 2012, 32(2):167-172.
17.	郑鸿, 何冰, 谭宏昌, 等. 不同手术入路髋臼假体放置角度差异对疗效的影响. 中华创伤骨科杂志, 2013, 15(8):734-736.
18.	Hirakawa K, Mitsugi N, Koshino T, et al. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res, 2001, (388):135-142.
19.	Eggli S, Hankemayer S, Muller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br), 1999, 81(5):843-845.

1. Brooks PJ. Dislocation following total hip replacement:causes and cures. Bone Joint J, 2013, 95-B(11 Suppl A):67-69.
2. Patel SR, Toms AP, Rehman JM, et al. A reliability study of measurement tools available on standard picture archiving and communication system workstations for the evaluation of hip radiographs following arthroplasty. J Bone Joint Surg (Am), 2011, 93(18):1712-1719.
3. Bosker BH, Verheyen CC, Horstmann WG, et al. Poor accuracy of freehand cup positioning during total hip arthroplasty. Arch Orthop Trauma Surg, 2007, 127(5):375-379.
4. 曹林虎, 谭伦, 吴超, 等. 人工全髋关节置换术中改良髋臼中心化技术对双下肢不等长的影响. 中国修复重建外科杂志, 2014, 28(2):213-217.
5. Pagnano W, Hanssen AD, Lewallen DG, et al. The effect of superior placement of the acetabular component on the rate of loosening after total hip arthroplasty. J Bone Joint Surg (Am), 1996, 78(7):1004-1014.
6. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2):217-220.
7. 康鹏德, 沈彬, 裴福兴. 髋关节翻修术中髋臼骨缺损的评估与重建. 中华骨科杂志, 2013, 33(12):1258-1264.
8. 刘瑞宇, 王坤正, 王春生, 等. 三维表面遮盖法结合多平面重建在成人髋关节发育不良全髋关节置换术前髋臼评估中的应用. 中国修复重建外科杂志, 2008, 22(6):643-645.
9. 李栋梁, 李佛保, 朱琦, 等. 人工全髋关节置换术中自体骨重建髋臼骨缺损的临床研究. 中华关节外科杂志(电子版), 2012, 6(1):39-43.
10. Barrack RL, Newland CC. Uncemented total hip arthroplasty with superior acetabular deficiency. Femoral head autograft technique and early clinical results. J Arthroplasty, 1990, 5(2):159-167.
11. Jeon DG, Kim MS, Cho WH, et al. Reconstruction with pasteurized autograft-total hip prosthesis composite for periacetabular tumors. J Surg Oncol, 2007, 96(6):493-502.
12. 裴福兴. 关节外科手术操作与技巧. 北京:人民卫生出版社, 2008:290-291.
13. 李雄峰, 管国华, 李建有. 髋关节发育不良人工全髋关节置换术中髋臼中心重建. 中国修复重建外科杂志, 2012, 26(9):1037-1040.
14. Ybinger T, Kumpan W. Enhanced acetabular component positioning through computer-assisted navigation. Int Orthop, 2007, 31 Suppl 1:S₃5-38.
15. Merle C, Grammatopoulos G, Waldstein W, et al. Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis. J Bone Joint Surg (Am), 2013, 95(22):e172.
16. 李军伟, 杨广辉, 王义生, 等. 髋臼卵圆窝在实现术前预期髋臼杯外展角中的参考价值. 中华骨科杂志, 2012, 32(2):167-172.
17. 郑鸿, 何冰, 谭宏昌, 等. 不同手术入路髋臼假体放置角度差异对疗效的影响. 中华创伤骨科杂志, 2013, 15(8):734-736.
18. Hirakawa K, Mitsugi N, Koshino T, et al. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res, 2001, (388):135-142.
19. Eggli S, Hankemayer S, Muller ME. Nerve palsy after leg lengthening in total replacement arthroplasty for developmental dysplasia of the hip. J Bone Joint Surg (Br), 1999, 81(5):843-845.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION MODE SELECTION OF ACETABULAR BONE DEFECT AND EFFECT ON ACETABULAR CUP POSITION IN CEMENTLESS TOTAL HIP ARTHROPLASTY

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