Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zhongyuan , ZHAO Jinwei ,  HUANG Xiangjie , JIANG Hexun , XU Ziyao

Department of Bone and Joint, Wendeng Orthopedic Hospital of Shandong Province, Weihai Shandong, 264400, P.R.China;

Corresponding author：

HUANG Xiangjie, Email: wdzghuangxj@163.com

Keywords：

Hip; revision; bone defect; acetabulum; three-dimensional printing

DOI：

10.7507/1002-1892.201905010

Video：

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Objective To investigate the short-term effectiveness of three-dimensional (3D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision.Methods Between August 2014 and December 2015, the 3D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of 14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was (38.17±8.87) mm and the horizontal position was (35.62±9.12) mm.Results The operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months (mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation (t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42° (mean, 39.4 °) and the anteversion angle was 13-18 ° (mean, 14.6°). The height and horizontal position of rotation center of affected hip were (22.08±8.33) mm and (29.03±6.28) mm, respectively, showing significant differences when compared with those before operation (P<0.05); there was no significant difference when compared with those of healthy hip [(28.62±7.73), (27.29±4.22) mm] (P>0.05). During the follow-up, there was no complication such as prosthesis loosening, dislocation, or periprosthetic fracture.Conclusion In hip revision, 3D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of acetabulum, provide a stable supporting structure for the acetabular cup, reconstruct the relatively normal rotation center of the hip joint, avoid iatrogenic bone loss, and achieve satisfactory functional recovery of the hip. The long-term effectiveness needs further follow-up.

Citation： ZHANG Zhongyuan, ZHAO Jinwei, HUANG Xiangjie, JIANG Hexun, XU Ziyao. Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1516-1520. doi: 10.7507/1002-1892.201905010 Copy

1.	Van Kleunen JP, Lee GC, Lementowski PW, et al. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty, 2009, 24(6 Suppl): 64-68.
2.	穆文博, 胥伯勇, 郭文涛, 等. 应用 cup-cage 技术重建 Paprosky ⅢB 型髋臼骨缺损的早期疗效观察. 中华骨科杂志, 2017, 37(7): 393-400.
3.	Grappiolo G, Loppini M, Longo UG, et al. Trabecular metal augments for the management of Paprosky type Ⅲ defects without plevic discontinuity. J Arthroplasty, 2015, 30(6): 1024-1029.
4.	Klatte TO, Kendoff D, Sabihi R, et al. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study. J Arthroplasty, 2014, 29(7): 1443-1448.
5.	Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
6.	黄勇, 周一新, 郭盛杰, 等. 钽金属骨小梁臼杯联合钽金属加强块重建髋臼严重骨缺损的临床研究. 中华关节外科杂志(电子版), 2015, 9(6): 732-739.
7.	郭盛杰, 黄勇, 唐浩, 等. 钽金属骨小梁臼杯联合钽金属加强块重建 PaproskyⅢ型髋臼骨缺损的近期疗效. 中华骨科杂志, 2016, 36(23): 1479-1486.
8.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-34.
9.	Laehiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetablar components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
10.	王百盛, 张敬东, 韩文锋, 等. 3-D 打印技术辅助人工全髋关节置换术治疗 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形一例. 中国修复重建外科杂志, 2018, 32(1): 125-127.
11.	杨龙, 王建吉, 刘国勇, 等. 3D 打印技术在髋臼发育不良髋关节置换中的初步应用. 中国矫形外科杂志, 2016, 24(17): 1550-1553.
12.	刘曦明, 曾文波. 3D 打印技术在骨盆髋臼骨折手术治疗中的研究进展. 创伤外科杂志, 2018, 20(1): 1-5.
13.	赵星, 余黎, 陶圣祥, 等. 3D 打印技术在严重肱骨远端骨缺损治疗中的应用观察. 中国修复重建外科杂志, 2018, 32(12): 1534-1539.
14.	吴敏, 官建中, 肖玉周, 等. 3-D 打印技术辅助经皮撬拨空心钉内固定治疗移位的跟骨关节内骨折. 中国修复重建外科杂志, 2017, 31(11): 1316-1321.
15.	姚坚, 丁海. 计算机导航及机器人技术辅助膝关节单髁置换术的研究进展. 中国修复重建外科杂志, 2017, 31(1): 110-115.
16.	陈宣煌, 余正希, 吴长福, 等. Quadrant 系统下 3D 打印导航模块辅助腰椎精准植钉的应用研究. 中国修复重建外科杂志, 2017, 31(2): 203-209.
17.	苗秋菊, 丁焕文, 黄敏强, 等. 3-D 打印导航模板辅助肘关节肿瘤切除及个性化肘关节置换术的初步应用. 中国修复重建外科杂志, 2017, 31(4): 385-391.
18.	夏志勇, 马康康, 李凯, 等. 3D 打印钛合金骨小梁金属臼杯、垫块在全髋关节置换翻修术中的应用. 中国骨与关节损伤杂志, 2017, 32(2): 121-124.

1. Van Kleunen JP, Lee GC, Lementowski PW, et al. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty, 2009, 24(6 Suppl): 64-68.
2. 穆文博, 胥伯勇, 郭文涛, 等. 应用 cup-cage 技术重建 Paprosky ⅢB 型髋臼骨缺损的早期疗效观察. 中华骨科杂志, 2017, 37(7): 393-400.
3. Grappiolo G, Loppini M, Longo UG, et al. Trabecular metal augments for the management of Paprosky type Ⅲ defects without plevic discontinuity. J Arthroplasty, 2015, 30(6): 1024-1029.
4. Klatte TO, Kendoff D, Sabihi R, et al. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study. J Arthroplasty, 2014, 29(7): 1443-1448.
5. Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
6. 黄勇, 周一新, 郭盛杰, 等. 钽金属骨小梁臼杯联合钽金属加强块重建髋臼严重骨缺损的临床研究. 中华关节外科杂志(电子版), 2015, 9(6): 732-739.
7. 郭盛杰, 黄勇, 唐浩, 等. 钽金属骨小梁臼杯联合钽金属加强块重建 PaproskyⅢ型髋臼骨缺损的近期疗效. 中华骨科杂志, 2016, 36(23): 1479-1486.
8. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-34.
9. Laehiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetablar components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
10. 王百盛, 张敬东, 韩文锋, 等. 3-D 打印技术辅助人工全髋关节置换术治疗 Crowe Ⅳ 型髋关节发育不良合并股骨近段畸形一例. 中国修复重建外科杂志, 2018, 32(1): 125-127.
11. 杨龙, 王建吉, 刘国勇, 等. 3D 打印技术在髋臼发育不良髋关节置换中的初步应用. 中国矫形外科杂志, 2016, 24(17): 1550-1553.
12. 刘曦明, 曾文波. 3D 打印技术在骨盆髋臼骨折手术治疗中的研究进展. 创伤外科杂志, 2018, 20(1): 1-5.
13. 赵星, 余黎, 陶圣祥, 等. 3D 打印技术在严重肱骨远端骨缺损治疗中的应用观察. 中国修复重建外科杂志, 2018, 32(12): 1534-1539.
14. 吴敏, 官建中, 肖玉周, 等. 3-D 打印技术辅助经皮撬拨空心钉内固定治疗移位的跟骨关节内骨折. 中国修复重建外科杂志, 2017, 31(11): 1316-1321.
15. 姚坚, 丁海. 计算机导航及机器人技术辅助膝关节单髁置换术的研究进展. 中国修复重建外科杂志, 2017, 31(1): 110-115.
16. 陈宣煌, 余正希, 吴长福, 等. Quadrant 系统下 3D 打印导航模块辅助腰椎精准植钉的应用研究. 中国修复重建外科杂志, 2017, 31(2): 203-209.
17. 苗秋菊, 丁焕文, 黄敏强, 等. 3-D 打印导航模板辅助肘关节肿瘤切除及个性化肘关节置换术的初步应用. 中国修复重建外科杂志, 2017, 31(4): 385-391.
18. 夏志勇, 马康康, 李凯, 等. 3D 打印钛合金骨小梁金属臼杯、垫块在全髋关节置换翻修术中的应用. 中国骨与关节损伤杂志, 2017, 32(2): 121-124.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision

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