Reconstruction Strategy And Curative Effect Observation Of The Acetabular Bone Deficiency In Total Hip Arthroplasty

Objective: To analysis the types and characteristics of acetabular bonedeficiency in total hip arthroplasty in order to discuss the reconstructionstrategy and curative effect combined with cases,Waiting for providing somereference to the actual clinical work.Method: Patients were selected from the china-japan union Hospitalfrom January2009to July2011,the cases were studied retrospectively andanalyzed with acetabular bone deficiency in primary or revision hiparthroplasty.20patients(21hips) were followed up for an average period of9.6months (3~24months).8were men,12were female, aged22to69years,average45years old; The left hip in7cases, right in14cases; The primarysurgery was done in10cases, revision surgery in11hips, the average time inrevision cases was14.5years (3m-onths to21years) from the primary surgery.According to Paprosky type; the cases were defined as Paprosky Ⅱ A in5, ⅡBin9cases, ⅡC in2cases, ⅢA in5cases. Acetabular bone defect wasreconstructed in either the biology or cement fixed way impacted with particleor structural bone, titanium nets cup, reinforcement rings. In21hips ofacetabular bone defect, reinforcement rings combined with bone graft wereused in6hips(5patients),impacted morselized bone grafting techniquecombined with titanium nets cup were used in1case,structural bone graftcombined with tatanium nets cup were used in1case, morselized bone graftswere used in5cases,only structural bone grafts were used in8cases.Functional recoveries of hip joint were assessed by Harris evaluation criteria,which were recorded in preoper ative,3months postoperative and the lastfollow-up. The hip X-ray imagings were taken in preoperative and the day1,3 months, six months, one year, two years after surgery. Acetabular prosthe-siesis bone dissolution and bone healing were observed in the X-ray. Postope-rative and last follow-up image were collected by using computer software. Aline through bilateral teardrop was defined as the horizontal reference line, Aline through the bottom of the teardrop Perpendicular to horizontal referenceline was defined as the vertical reference line. The lateral distance of the femor-aral head center was measured perpendicular to the vertical reference line,thesuperior distance was measured perpendicular to the horizontal referenceline,the abduction angle was measured as the angle between the horizontalreferencce line and the cup wire.All the data were analysis by using thestatistical analysis soft SPSS12.0.Results: There were20cases (21hips) with complete information bytelephone and outpatient follow-up. The mean follow-up time was9.6months(3-24months). The harris hip score of the last follow-up was (83.82±8.61)compared with the preoperative (43.83±13.2) which is statistically significant(P<0.05).the lateral distance of the femoral head center of the last follow-up was(28.84±5.57mm) which has no statistical significance(P＞0.05) comparedwith the first postoperation(28.02±6.02mm). the superior distance of thefemoral head center of the last follow-up was (19.05±9.25mm) which has nostatistical significance (P＞0.05) compared with the first postoperation(18.61±9.45mm), the abduction angle of the last follow-up was(47.52±9.00°)which has no statistical significance(P＞0.05) compared with the firstpostoperation(47.48±8.90°).Until the last follow-up,we did not observe anycases failed due to infection or prosthesis breakage, despite we find thephenomenon that grafts had different degrees of bone dissolution and bonereconstruction, but the acetabular grafts were all healed, no obvious bright linewas observed between the acetabular and prosthesis there was no loosening ofprosthesis, even in revision cases. Conclusion:1The. paprosky types contribute to the accurate assessment of acetabulardefects, and predictably choice of renewal strategy.2The adoption of bone graft technology not only reconstructs theacetabular integrity, but also provides the reserve of bone mass to revisionagain.3The applications of the acetabular reinforcement rings can effectivelyrepair severe acetabular bone deficiency, and the mastery of surgical skills iskey to reduce the complications.4This study is a tentative analysis. Due to the limited number of casesand the short follow-up time, its long-term results need to be further studied.