Objective To investigate the effectiveness of the acetabular reconstruction surgery in children pathological dislocation of the hip joint. Methods Between January 2006 and January 2011, 59 patients (59 hips) with pathological dislocation were treated by open reduction combined with acetabular reconstruction surgery. There were 22 boys and 37 girls, aged from 1 to 15 years (mean, 4.9 years). There were 9 cases of hip subluxation and 50 cases of hip joint dislocation, which were caused by suppurative arthritis of the hip (33 cases) and tuberculosis of the hip (26 cases). The diseases duration ranged from 1 month to 10 years. At preoperation Harris hip score was 43-78 (mean, 61); 14 cases had normal acetabular index (AI), 32 cases had slightly increased AI, and 13 cases had significantly increased AI. The concomitant diseases included acetabular destruction in 28 cases; avascular necrosis of the femoral head in 25 cases, femoral head partial defect in 12 cases, femoral head complete defect in 6 cases, and femoral head and neck defects in 3 cases; 25 cases had increased anteversion angle; and 9 cases had varus deformity. Results Immediately postoperative X-ray films showed center reduction in all the hips. Healing of incision by first intention was achieved in 55 cases, and delayed healing in 4 cases. Fifty-three children were followed up 2 to 5 years (mean, 3 years). No re-dislocation of the hip occurred during follow-up. Thirty-eight cases had normal AI, 15 cases had slightly increased AI. The anteversion angle was 15-25 ° (mean, 20 ° ); the neck shaft angle was 110-140 ° (mean, 125 ° ); and the anatomical relation between the head and neck returned to normal. After 2 years, 18 cases had normal function of the hip joint; 30 cases had mild limitation of flexion and rotation; and 5 cases had fibrous ankylosis. The Harris hip score was 62-95 (mean, 87). Conclusion Pathological dislocation caused by neonatal acute suppurative arthritis of the hip and the hip joint tuberculosis is often associated with severe bone destruction and deformity of the acetabular and femoral head and neck. Treatment should strictly follow the principle of individual. Proper acetabular reconstruction should be selected according to pathological changes of the hip; if combined with the femoral head and neck reconstruction processing, the satisfactory results can be obtained.
【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.
Objective To evaluate the effectiveness of acetabulum reinforcement ring (Cage) with allograft bone for reconstructing acetabular defects in hip revision. Methods Between February 2006 and August 2010, 14 patients (14 hips) with serious acetabular bone defects after total hip arthroplasty underwent acetabular reconstruction by using Cage with allograft bone. There were 6 males and 8 females with a mean age of 59.2 years (range, 45-76 years). The mean time between first replacement and revision was 7.2 years (range, 5-12 years). The revision causes included infection in 8 cases, osteolysis and aseptic loosening in 6 cases. The hip function Harris score was 37.7 ± 5.3. According to America Association of Orthopedic Surgeon (AAOS) standard, the acetabular defect was classified as type III in 8 cases and as type IV in 6 cases. Results All incisions healed by first intention, and no complication occurred. The patients were followed up 14-62 months (mean, 44 months). The pain was relieved or disappeared. At last follow-up, the Harris score was 89.7 ± 3.2, showing significant difference when compared with preoperative score (t= — 44.40, P=0.04). No loosening of the acetabular component or osteolysis was found in 14 hips. No absorption or collapse of the allograft was observed in all patients. Conclusion Cage with allograft bone is a useful method of reconstructing acetabular bone defects in hip revision. Further follow-up is needed to assess the long-term effectiveness.
Objective To evaluate the medium-term results of uncemented acetabular revision with impacted deep frozen morsell ized allografts. Methods From April 1995 to December 2001, 58 cases (62 hips) were performed acetabularrevision by use of deep frozen morsel ized allograft firmly impacted into local ized defects as well as the entire acetabular cavity, followed by insertion of a uncemented cup with supplementary screw fixation. There were 32 males (34 hips) and 26 females (28 hips), with age of (49.6 ± 15.4) years old. Among 62 hips, 32 hips involved in left side and 30 hips involved in right side. The cause of revision was aseptic loosening of the cup in 56 hips, septic loosening of the cup in 3 hips, and polyethylene l iner dislodging with severe acetabular osteolysis in 3 hips. The average interval between the primary total hip arthroplasty and the revision was (10.1 ± 3.9) years. According to the American Academy of Orthopaedic Surgeons classification, 42 hips belonged to type II and 20 hi ps to type III acetabular defects. The cl inical and radiographic results were analyzed postoperatively. Results All wounds healed by first intention. No deep venous thrombosis and infection occurred postoperatively. All patients were followed up 6-13 years (average 8.1 years). The Harris score was improved from 61.1 ± 10.2 preoperatively to 92.0 ± 7.3 postoperatively, showing significant difference between preoperation and postoperation (P lt; 0.05). The results were excellent in 46 hips, good in 10 hips, fair in 4 hips, and poor in 2 hips, the excellent and good rate was 90.3%. The time for allograft incorporation was (12.5 ± 4.4) months after operation. The annual polyethylene l iner wear rate was (0.13 ± 0.09) mm. Linear and cavitary osteolysis was observed in 2 and 12 hips, respectively. Heterotopic ossification developed in 7 hi ps (11.3%); 3 hi ps were rated as grade I, 3 as grade II, and 1 as grade III according to Brooker classification. One cup underwent revision for asepticloosening and 2 were defined as radiographic failures. Kaplan-Meier survival rate of the cup was 94.2% ± 3.3% at 8 years after operation. Conclusion The combination of uncemented cup component with deep frozen morsel ized allografts seems to be a rel iable solution for restoring bone stock, relocating the hip center, and stabil izing the cup in acetabular revision, and provides favorable medium-term cl inical and radiographic results.
ObjectiveTo investigate the reconstruction mode selection of acetabular bone defect and the effect on the acetabular cup position in cementless total hip arthroplasty (THA). MethodsA 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. ResultsThe 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). ConclusionIn 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.