Study On The Comparison Of Paprosky Type Ⅱ And Ⅲ Acetabular Bone Defects Reconstruction Between Application Of Large Bio-acetabular Cups And Reinforcement Materials

Objective:To explore the clinical application and experience of acetabular reconstruction of Paprosky type II and III acetabular bone defects with large bio-acetabular cups and reinforcement materials.Methods:The patients were collected,arranged and analyzed,who were preformed total hip arthroplasty in our hospital from January 2014 to August 2018.By pelvic frontal X-ray films,three-dimensional reconstruction CT of the hip joint,and necessary 3D printing technology,the acetabular bone defect was fully assessed to select the patients who were assessed as Paprosky type II and III acetabular bone defect before operation.The real situation of acetabular bone defect was explored and the patients were classified by AAOS classification system during operation.Among the available cases,seventeen cases of total acetabular joint arthroplasty were performed with large bio-acetabular cups(17 hips): There were 7 males(7 hips)and 10 females(10 hips)with an average age of 63.5 years old,ranging from 40 to 75 years old.21 patients(21 hips)were performed acetabular reconstruction with reinforcement materials: 12 males(12 hips)and 9 females(9 hips)with an average age of 60.6 years,ranging from 43 to 72 years old.Through comparative analysis on preoperative and postoperative iconography and intraoperative specific conditions of the two groups,the rationality of complex acetabular reconstruction methods was determined.Then by counting Harris evaluation of the preoperative and postoperative hip joint of the two groups of patients,prosthesis bone ingrowth(using standard evaluation on Delee-Charnley partition allocation method and Anderson bone ingrowth iconography),and operation time,intraoperative bleeding and postoperative complication,following up comparative analysis were conducted.Statistics were analyzed with available data application SPSS 22.0 statistics software package during follow-up.Results:All the patients were followed up for a mean period of(24±17)months.Harris score of the large bio-acetabular cup patients group increased from the preoperative average scores(35.5±11.2)to the postoperative average scores(84.4±9.5)at the last follow-up(p<0.05);and Harris score of the reinforcement material patients group increased from the preoperative average scores(30.1±9.4)to the post-operative average scores(85.2±8.3)at the last follow-up(p<0.05);The operation time of the large bio-acetabular cup group was(115±14)min and the intraoperative bleeding volume was(450±71)mL,while the operation time of the reinforcement material patients group was(180±63)min and the intraoperative bleeding volume was(1200±750)mL.(all p<0.05).During the follow-up,the large bio-acetabular cups of all patients contacted well with their host bone,which were at good position and condition without the fracture of the fixed screw and presented a good effect on osseointegration in all areas of combined bone grafting.As for the part of larger serious bone defect reconstructed with reinforcing materials,bone ingrowth of reinforcement materials has no signs of loosening and displacement,and there was no significant difference in short-term and long-term effect after operation between the two groups of patients.The postoperative last follow-up and preoperative Harris score were improved significantly in the two groups of patients,but there was no significant difference between large bio-acetabular cups and reinforcement material group on postoperative joint function(p>0.05).However,there were significant differences between the two groups on intraoperative condition,postoperative complications and rehabilitation process,revealing in intraoperative bleeding volume,operation time,rehabilitation time and complications after operation,etc.Thus the bio-acetabular cup group was superior to reinforcement material group.Conclusion:In total hip joint arthroplasty,part of Paprosky type II and III acetabular bone defects can be reconstructed by using large bio-acetabular cups,thus reducing the complex problems caused by the acetabular reconstruction reinforcement materials including reinforcement mesh cup,tantalum block and bone graft.