ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli. MethodsBetween January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was (5.70±4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. ResultsThe average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score (t=-27.68, P=0.00); the protrusio acetabuli was (-1.11±0.45) mm, showing significant difference when compared with preoperative value (t=5.66, P=0.00). No loosening of acetabular components was found. ConclusionFor RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.
【Abstract】 Objective To evaluate the method and the early effectiveness of total hip arthroplasty in the treatment of protrusio acetabuli. Methods Between January 2006 and February 2010, 16 cases (16 hips) of protrusio acetabuli were treated, including 6 males and 10 females with an average age of 56.5 years (range, 39-72 years). The median disease duration was 6.4 years (range, 1 year and 6 months to 35 years). Involved hips included 7 left hips and 9 right hips; 3 patients had primary protrusio acetabuli and 13 patients had secondary protrusio acetabuli. The preoperative Harris score was 49.5 ± 5.5. According to Dunlop et al. classification criterion, there were 3 cases of mild, 9 cases of moderate, and 4 cases of severe. All patients received total hip arthroplasty with bone graft and cementless prosthesis for recovery of femoral offset and acetabular center of rotation. Results All incisions healed by first intention without complication of infection, deep venous thrombosis, or nerve injury. All patients were followed up 12-62 months with an average of 37 months. The Harris score at last follow-up was 90.5 ± 4.5, showing significant difference (t=49.578, P=0.000) when compared with preoperative score. The X-ray films showed that no prosthesis loosening or subsidence was observed, and bone graft healed with no sign of re-protrusion. Conclusion In treatment of protrusio acetabuli, total hip arthroplasty with bone graft and cementless prosthesis can recover the femoral offset and acetabular center of rotation and provide satisfactory early effectiveness.
目的 探讨使用生物型非骨水泥假体治疗髋臼内陷症的近期疗效。 方法 2007年6月－2010年5月，对11例12髋髋臼内陷患者行生物型假体全髋关节置换术。男2例，女9例；年龄38～57岁，平均47.3岁。其中继发于类风湿性关节炎7例，创伤4例；病程1～18年，平均8.9年；轻度髋臼内陷6髋，中度髋臼内陷6髋。采用Harris评分标准进行临床疗效评估，摄X线片进行影像学评估。 结果 术后第2天X线片示，人工股骨头距Kohler’s线外移（1.42 ± 2.27）mm，较术前股骨头内陷（?5.17 ± 2.04）mm明显改善（P＜0.05）。术后1周，患者Harris评分为（85.75 ± 4.73）分，较术前（39.75 ± 5.24）分显著提高（P＜0.05）。术后1年X线片示髋臼假体与髋臼内侧壁无透亮线，已骨融合。术后患者获随访2～5年。髋臼假体均无松动移位、脱位或移植骨的吸收。 结论 使用生物型非骨水泥假体结合自体骨移植治疗髋臼内陷症，能有效恢复髋臼运动中心的解剖位置，近期临床疗效满意。