Reconstruction of severe acetabular defects (Paprosky type III A) in total hip arthroplasty using modular tantalum augments in combination with a cemented cup.

IF 2 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI:10.1007/s00264-024-06334-x

David Spranz, Lisa-Marie Müller, Raphael Trefzer, Pit Hetto, Timo Nees, Tobias Renkawitz, Tilman Walker, Tobias Reiner

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Abstract

Purpose: Acetabular defect reconstruction can be a complex and challenging surgical procedure, with stable long-term fixation of the implants remaining the ultimate goal. The purpose of this study was (1) to evaluate the radiological and clinical outcome of complex acetabular reconstruction surgery with the use of modular tantalum TM augments in combination with cemented revision cups; (2) to investigate blood tantalum concentrations in these patients; and (3) to report complications and mechanisms of failure related to this procedure at mid-term follow-up (mean 4.5 years).

Methods: We retrospectively reviewed 29 patients (29 hips) with severe acetabular bone loss (Paprosky type III A) reconstructed using a modular tantalum TM augment in combination with a cemented cup. We evaluated the implant survival and the radiological and clinical outcomes after a mean follow-up of 4.5 years (SD 2.2; range 8.4 - 2.1 years) using patient reported outcome scores (PROMs). Blood samples were analysed regarding tantalum concentration and compared with a control group.

Results: The cumulative survival rate at 4.5 years with the endpoint "revision of the acetabular component for any reason" was 96.2% (95% Confidence Interval 75.7-99.5). The PROMs improved significantly up to the latest follow-up, and radiographic data showed only one patient with signs of initial implant migration with a broken screw and a change of the position of the augment and the cup. Mean blood tantalum concentrations were significantly higher in the study group (0.16 µg/L) compared to the control group (0.002 µg/L) (P < 0.001).

Conclusions: This study has demonstrated good mid-term (mean 4.5 years) clinical and radiological outcomes of modular tantalum TM augments in combination with a cemented cup for the reconstruction of major acetabular defects. Mean blood tantalum concentrations were increased in patients with stable tantalum implants compared to healthy controls.

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在全髋关节置换术中使用模块化钽增量材料和骨水泥髋臼杯重建严重的髋臼缺损（Paprosky III A 型）。

目的：髋臼缺损重建是一项复杂且具有挑战性的外科手术，植入物的长期稳定固定是最终目标。本研究的目的是：(1) 评估使用模块化钽 TM 增量体结合骨水泥翻修杯进行复杂髋臼重建手术的放射学和临床结果；(2) 调查这些患者的血钽浓度；(3) 报告中期随访（平均 4.5 年）时与该手术相关的并发症和失败机制：我们回顾性研究了29例严重髋臼骨缺损（Paprosky III A型）患者（29个髋关节），他们均使用模块化钽TM增量体结合骨水泥髋臼杯进行了重建。我们使用患者报告结果评分（PROMs）对平均随访 4.5 年（SD 2.2；范围 8.4 - 2.1 年）后的植入物存活率以及放射学和临床结果进行了评估。对血液样本中的钽浓度进行了分析，并与对照组进行了比较：以 "因任何原因进行髋臼组件翻修 "为终点，4.5 年的累积存活率为 96.2%（95% 置信区间为 75.7-99.5）。截至最近一次随访，患者的PROMs明显改善，放射学数据显示，只有一名患者出现了螺钉断裂和增量体与髋臼杯位置改变等初始植入物移位迹象。研究组的平均血钽浓度（0.16 µg/L）明显高于对照组（0.002 µg/L）（P 结论：研究组的血钽浓度明显高于对照组（0.002 µg/L）：这项研究表明，模块化钽 TM 增量材料结合骨水泥髋臼杯重建重大髋臼缺损的中期（平均 4.5 年）临床和放射学效果良好。与健康对照组相比，使用稳定钽植入物的患者血液中的平均钽浓度有所增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.