Clinical Limitation And Analysis Of Acetabular Defect Classification Of Paprosky

Objective:In order to accurately assess the acetabular bone defect and predict the difficulty of the operation and choose the best method for acetabular reconstruction according to the actual situation during the operation,through deeper understanding and improvement of Paprosky type.Methods:A total of 36 patients(36 hips)who underwent total revision hip arthroplasty in our hospital from January 2008 to January 2018 were collected.Among the cases,there were 16 males(16 hips)and 20 females(20 hips)whose average age was 58 years old(range: 31~76 years).As to the reason,there were 30 hips were revised for aseptic loosening,and 6 hips were revised for severe wear of the artificial prosthesis.According to the Paprosky acetabular defect classification,there were 13 hips of type ?B,7 hips of type?C,8 hips of type ?A,and I8 hips of type ?B.The cases were divided into two groups with 2013 as the boundary,and the changes of acetabular lateral revision methods in the two groups were compared and analyzed.The position of the prosthesis and screws,the wear of the lining,the X-ray transmission line,and the gap between the prosthesis and the bone tissue were examined according to the X-ray films before and after the operation to determine the displacement of the prosthesis and prosthesis bone ingrowth,statistics of operation time,intraoperative bleeding,surgical cost,and hip Harris scores to evaluate different revision methods,determine the rationality of complex acetabular reconstruction methods,and summarize and analyze the correspondence between the classification of acetabular bone defects and the current mainstream acetabular reconstruction methods.Results:All 36 patients were followed up for an average period of(24 ± 15)months.The revision cases involved the use of bio-type acetabular cups,tantalum block implants,reinforced cups(cage,ring)combined with bone grafting.The use of bio-type acetabular cups and implants with tantalum blocks was significantly higher in 2013-2018.Reinforcement cups were more commonly used in the 2008-2013 group.Among them,the Harris score of the biotype acetabular cup group increased from the average(36.1 ± 2.4)points before surgery to the average(81.1 ± 14.2)points at the last follow-up(p <0.05).The postoperative period was 3 to 7 days.The cost was 65,000 RMB.The intraoperative bleeding was 400-800 ml,and the average operation time was 2.1 hours.The Harris scores of the patients in the metal-enhanced block group were increased from the average preoperative(35.1 ± 2.8)points to to the average(80.8 ± 16.3)points at the last follow-up.(p <0.05),The postoperative period was 3 to 10 days.The cost was 100,000 RMB.The intraoperative bleeding was 650 to 800 ml,and the average operation time was 2.5 hours;The Harris score of patients in the enhanced cup group increased from the average preoperative(37.1 ± 3.3)points to the average postoperative follow-up(80.1 ± 14.8)points(p <0.05).The postoperative time was 5 to 14 days.The average operation cost was 69000 RMB.The intraoperative blood loss was 700-1200 ml,and the average operation time was 2.8 hours.During the follow-up period,one patient had dislocation in the bio-cup group and two patients in the enhanced cup group had loose prosthesis.The rest of the patients had good contact with the host bone,and the position and condition of the cup were good;All patients had significant improvement in the last follow-up compared with the preoperative Harris score,and there was no significant difference in postoperative joint function(p> 0.05);The postoperative complications and rehabilitation process are significantly different,which are manifested in terms of intraoperative blood loss,surgical cost,operation time,postoperative time and postoperative complications,etc.Through a comprehensive comparison,Jumbo cup and tantalum Implanted refurbishment methods are the mainstream refurbishment methods today,and the repair effect is better.Conclusion:1.Paprosky acetabular defect classification has its defects.Paprosky classification cannot fully meet the understanding of acetabular defects.The revision strategy corresponding to each type is different from the current revision concept.The acetabular reconstruction method forms a one-to-one correspondence.2.There is a deviation between preoperative evaluation and intraoperative acetabular bone defect.Accurate evaluation also needs to be determined by 3D CT and 3D printing.3.Paprosky acetabular bone defect is still the most direct,convenient and effective way to recognize acetabular defect.