Intussusception Allograft Prosthetic Composites in Total Hip Arthroplasty: A Salvage Operation for Extensive Femoral Bone Loss.
Intussusception Allograft Prosthetic Composites in Total Hip Arthroplasty: A Salvage Operation for Extensive Femoral Bone Loss.
复制标题
全髋关节置换术中的肠套叠同种异体移植假体复合材料：广泛股骨丢失的挽救手术。
DOI：
10.1016/j.arth.2023.03.038
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Lewallen,DavidG
中科院分区：
文献类型：
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作者：
Hadley,MatthewL;Shirley,MatthewB;Pulido,LuisF;Lewallen,DavidG
背景同种异体骨假体复合材料（APC）已被用于全髋关节置换术（THA）的翻修，以治疗股骨大面积骨缺损或畸形。已经提出了肠套叠或“套叠”APC技术，以增加该界面的接触面积，并提供优于传统方法的上级机械固定。本研究的目的是介绍据我们所知，最大系列的伸缩式APC THA，沿着手术技术细节和中期（平均5-10年）临床结果。MethodsBetween 1994 and 2015，在一家机构回顾性审查了46例使用股骨近端伸缩式APC进行的翻修THA。通过Kaplan-Meier方法计算总生存率、无再手术生存率和结构生存率。此外，进行放射学分析，以评估组件松动，愈合在APC主机接口，和吸收的allograft.ResultsAt 10年，患者的总体生存率为58%，再手术生存率为76%，和构建生存率为95%。20%（n = 9）进行了再次手术，仅2个结构需要切除。末次随访时进行的影像学分析显示，没有影像学股骨柄松动的情况，APC宿主部位的愈合率为86%，23%有一些同种异体骨吸收的迹象，54%的转子愈合。平均术后Harris髋关节评分为71分（范围，46-100）conclusionTelescoping APC是技术上的要求，但提供了可靠的机械固定重建股骨近端大的骨缺损在翻修THA具有良好的结构生存率，可接受的再手术率，和良好的临床结局。
BackgroundAllograft prosthetic composites (APCs) have been used to perform revision total hip arthroplasty (THA) for massive femoral bone loss or deformity. Intussusception, or “telescoping”, APC techniques have been proposed to enhance the contact area of this interface and provide superior mechanical fixation over conventional methods. The purpose of this study is to present to our knowledge, the largest series of telescoping APC THAs, along with surgical technique details and midterm (average 5-10 years) clinical results.MethodsBetween 1994 and 2015, 46 revision THAs performed with proximal femoral telescoping APCs were retrospectively reviewed at a single institution. Overall survival, reoperation-free survival, and construct survival rates were calculated via Kaplan-Meier methods. In addition, radiographic analyses were performed to evaluate for component loosening, union at the APC-host interface, and resorption of the allograft.ResultsAt 10 years, the overall patient survival was 58%, reoperation-free survival was 76%, and construct survival was 95%. Reoperation was performed in 20% (n = 9) and only 2 constructs required resection. Radiographic analyses performed at latest follow-up revealed no instances of radiographic femoral stem loosening, an 86% union rate at the APC-host site, 23% with signs of some allograft resorption, and a 54% trochanteric union. The mean postoperative Harris hip score was 71 points (range, 46-100).ConclusionTelescoping APCs are technically demanding, but provide reliable mechanical fixation for the reconstructing of large proximal femoral bone deficits in revision THA with excellent construct survivorship, acceptable reoperation rates, and good clinical outcomes.Level of EvidenceIV.