| Objective:The purpose of this retrospective study was to analyze the early clinical functional and radiographic results of severe acetabular bone defect reconstruction with metal augments.Methods:From January 2014 to January 2020,the clinical data of 10 patients with 10 hips of severe acetabular bone defect who underwent acetabular reconstruction with metal augments in the Department of Bone and Joint,The First Hospital of Jilin University were collected.The clinical evaluation were performed using Harris Hip Score(HHS)and visual analog score(VAS)of pain At preoperative and lastest follow-up.The immediate postoperative and latest follow-up radiographs were used to evaluate acetabular inclination,the presence of radiolucent lines(RLLs),osteolysis,the stability and bone ingrowth of the acetabular prosthesis and metal augment.Measure the difference between the height of the hip center of rotation and the limb-length discrepancy.Record intraoperative and postoperative complications and relevant treatment measures.Results:All 10 patients received complete follow-up,including 8 males and 2 females.The mean age of the patients at the time of surgery was 60.9 years(52-75)and the mean follow-up was 22.2months(3-42);One case was uderwent total hip arthroplasty for the first time,while the other 9 cases were uderwent revision of total hip arthroplasty.The time interval between the revision procedure and primary total hip arthroplasty was 10.1±4.6(0.5-17)years.There were 6 patients with a Paprosky IIIA acetabular defect and 4patients with a Paprosky IIIB acetabular defect.No patient had pelvic discontinuity.The hip function of the patients was significantly improved,and the HHS score increased from 26.5±6.8 points(15-35 points)preoperative to 83.9±4.2 points(78-92 points)at the latest follow-up,with a significant difference(p <0.05).The VAS decreased from 8.5±1.0 points(7-10 points)pretoperative to 2.0±0.7 points(1-3 points)at the latest follow-up,indicating the pain were significant alleviated(p <0.05).LLD improved significantly,from 2.5±0.8cm(1.0-4.0cm)pretoperative to 0.4±0.6 cm(0-1.5 cm)at the latest follow-up(p <0.05).The height of the hip center of rotation was reconstructed from 40.6±9.3mm(23.9-54.7mm)pretoperative to 18.1±5.8mm(8.7-25.0mm)at the latest follow-up(p <0.05).The inclination angle of the acetabular prosthesis was 39.9°±6.6°(28°-51°)at the latest follow-up.All acetabular prostheses and metal augments are well positioned.and have achieved well bone ingrowth.One patient had 1 degree heterotopic ossification.One patient had an acute periprosthetic infection 1 month after surgery,and was undertaken debridement,liner revision,combined with sensitive antibiotics and VSD negative pressure drainage therapy.The infection was still not effectively controlled after two and a half months.Hip dislocation occurred after 23 months postoperative in one case,and the patient was treated with reduction and internal fixation.Until the latest follow-up,no dislocation occurred again.Conclusions:Reconstruction of Paprosky type III acetabular defects with metal augments can significantly relieve pain symptoms and improve hip joint function.The metal augments can reconstruct hip center of rotation to the anatomical position,which helps to restore the normal biomechanics of hip.Long-term prosthesis survival rates and complications need further follow-up. |
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