Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zhongyuan , ZHAO Jinwei ,  HUANG Xiangjie , JIANG Hexun , XU Ziyao

Department of Bone and Joint, Wendeng Orthopedic Hospital of Shandong Province, Weihai Shandong, 264400, P.R.China;

Corresponding?author：

HUANG Xiangjie, Email: wdzghuangxj@163.com

Keywords：

Hip; revision; bone defect; acetabulum; three-dimensional printing

DOI：

10.7507/1002-1892.201905010

Video：

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Objective To investigate the short-term effectiveness of three-dimensional (3D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision.Methods Between August 2014 and December 2015, the 3D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of 14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was (38.17±8.87) mm and the horizontal position was (35.62±9.12) mm.Results The operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months (mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation (t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42° (mean, 39.4 °) and the anteversion angle was 13-18 ° (mean, 14.6°). The height and horizontal position of rotation center of affected hip were (22.08±8.33) mm and (29.03±6.28) mm, respectively, showing significant differences when compared with those before operation (P<0.05); there was no significant difference when compared with those of healthy hip [(28.62±7.73), (27.29±4.22) mm] (P>0.05). During the follow-up, there was no complication such as prosthesis loosening, dislocation, or periprosthetic fracture.Conclusion In hip revision, 3D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of acetabulum, provide a stable supporting structure for the acetabular cup, reconstruct the relatively normal rotation center of the hip joint, avoid iatrogenic bone loss, and achieve satisfactory functional recovery of the hip. The long-term effectiveness needs further follow-up.

Citation： ZHANG Zhongyuan, ZHAO Jinwei, HUANG Xiangjie, JIANG Hexun, XU Ziyao. Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1516-1520. doi: 10.7507/1002-1892.201905010 Copy

1.	Van Kleunen JP, Lee GC, Lementowski PW, et al. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty, 2009, 24(6 Suppl): 64-68.
2.	穆文博, 胥伯勇, 郭文濤, 等. 應用 cup-cage 技術重建 Paprosky ⅢB 型髖臼骨缺損的早期療效觀察. 中華骨科雜志, 2017, 37(7): 393-400.
3.	Grappiolo G, Loppini M, Longo UG, et al. Trabecular metal augments for the management of Paprosky type Ⅲ defects without plevic discontinuity. J Arthroplasty, 2015, 30(6): 1024-1029.
4.	Klatte TO, Kendoff D, Sabihi R, et al. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study. J Arthroplasty, 2014, 29(7): 1443-1448.
5.	Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
6.	黃勇, 周一新, 郭盛杰, 等. 鉭金屬骨小梁臼杯聯合鉭金屬加強塊重建髖臼嚴重骨缺損的臨床研究. 中華關節外科雜志(電子版), 2015, 9(6): 732-739.
7.	郭盛杰, 黃勇, 唐浩, 等. 鉭金屬骨小梁臼杯聯合鉭金屬加強塊重建 PaproskyⅢ型髖臼骨缺損的近期療效. 中華骨科雜志, 2016, 36(23): 1479-1486.
8.	Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-34.
9.	Laehiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetablar components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
10.	王百盛, 張敬東, 韓文鋒, 等. 3-D 打印技術輔助人工全髖關節置換術治療 Crowe Ⅳ 型髖關節發育不良合并股骨近段畸形一例. 中國修復重建外科雜志, 2018, 32(1): 125-127.
11.	楊龍, 王建吉, 劉國勇, 等. 3D 打印技術在髖臼發育不良髖關節置換中的初步應用. 中國矯形外科雜志, 2016, 24(17): 1550-1553.
12.	劉曦明, 曾文波. 3D 打印技術在骨盆髖臼骨折手術治療中的研究進展. 創傷外科雜志, 2018, 20(1): 1-5.
13.	趙星, 余黎, 陶圣祥, 等. 3D 打印技術在嚴重肱骨遠端骨缺損治療中的應用觀察. 中國修復重建外科雜志, 2018, 32(12): 1534-1539.
14.	吳敏, 官建中, 肖玉周, 等. 3-D 打印技術輔助經皮撬撥空心釘內固定治療移位的跟骨關節內骨折. 中國修復重建外科雜志, 2017, 31(11): 1316-1321.
15.	姚堅, 丁海. 計算機導航及機器人技術輔助膝關節單髁置換術的研究進展. 中國修復重建外科雜志, 2017, 31(1): 110-115.
16.	陳宣煌, 余正希, 吳長福, 等. Quadrant 系統下 3D 打印導航模塊輔助腰椎精準植釘的應用研究. 中國修復重建外科雜志, 2017, 31(2): 203-209.
17.	苗秋菊, 丁煥文, 黃敏強, 等. 3-D 打印導航模板輔助肘關節腫瘤切除及個性化肘關節置換術的初步應用. 中國修復重建外科雜志, 2017, 31(4): 385-391.
18.	夏志勇, 馬康康, 李凱, 等. 3D 打印鈦合金骨小梁金屬臼杯、墊塊在全髖關節置換翻修術中的應用. 中國骨與關節損傷雜志, 2017, 32(2): 121-124.

1. Van Kleunen JP, Lee GC, Lementowski PW, et al. Acetabular revisions using trabecular metal cups and augments. J Arthroplasty, 2009, 24(6 Suppl): 64-68.
2. 穆文博, 胥伯勇, 郭文濤, 等. 應用 cup-cage 技術重建 Paprosky ⅢB 型髖臼骨缺損的早期療效觀察. 中華骨科雜志, 2017, 37(7): 393-400.
3. Grappiolo G, Loppini M, Longo UG, et al. Trabecular metal augments for the management of Paprosky type Ⅲ defects without plevic discontinuity. J Arthroplasty, 2015, 30(6): 1024-1029.
4. Klatte TO, Kendoff D, Sabihi R, et al. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study. J Arthroplasty, 2014, 29(7): 1443-1448.
5. Whitehouse MR, Masri BA, Duncan CP, et al. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res, 2015, 473(2): 521-527.
6. 黃勇, 周一新, 郭盛杰, 等. 鉭金屬骨小梁臼杯聯合鉭金屬加強塊重建髖臼嚴重骨缺損的臨床研究. 中華關節外科雜志(電子版), 2015, 9(6): 732-739.
7. 郭盛杰, 黃勇, 唐浩, 等. 鉭金屬骨小梁臼杯聯合鉭金屬加強塊重建 PaproskyⅢ型髖臼骨缺損的近期療效. 中華骨科雜志, 2016, 36(23): 1479-1486.
8. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty, 1994, 9(1): 33-34.
9. Laehiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetablar components in revision hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(6): 543-548.
10. 王百盛, 張敬東, 韓文鋒, 等. 3-D 打印技術輔助人工全髖關節置換術治療 Crowe Ⅳ 型髖關節發育不良合并股骨近段畸形一例. 中國修復重建外科雜志, 2018, 32(1): 125-127.
11. 楊龍, 王建吉, 劉國勇, 等. 3D 打印技術在髖臼發育不良髖關節置換中的初步應用. 中國矯形外科雜志, 2016, 24(17): 1550-1553.
12. 劉曦明, 曾文波. 3D 打印技術在骨盆髖臼骨折手術治療中的研究進展. 創傷外科雜志, 2018, 20(1): 1-5.
13. 趙星, 余黎, 陶圣祥, 等. 3D 打印技術在嚴重肱骨遠端骨缺損治療中的應用觀察. 中國修復重建外科雜志, 2018, 32(12): 1534-1539.
14. 吳敏, 官建中, 肖玉周, 等. 3-D 打印技術輔助經皮撬撥空心釘內固定治療移位的跟骨關節內骨折. 中國修復重建外科雜志, 2017, 31(11): 1316-1321.
15. 姚堅, 丁海. 計算機導航及機器人技術輔助膝關節單髁置換術的研究進展. 中國修復重建外科雜志, 2017, 31(1): 110-115.
16. 陳宣煌, 余正希, 吳長福, 等. Quadrant 系統下 3D 打印導航模塊輔助腰椎精準植釘的應用研究. 中國修復重建外科雜志, 2017, 31(2): 203-209.
17. 苗秋菊, 丁煥文, 黃敏強, 等. 3-D 打印導航模板輔助肘關節腫瘤切除及個性化肘關節置換術的初步應用. 中國修復重建外科雜志, 2017, 31(4): 385-391.
18. 夏志勇, 馬康康, 李凱, 等. 3D 打印鈦合金骨小梁金屬臼杯、墊塊在全髖關節置換翻修術中的應用. 中國骨與關節損傷雜志, 2017, 32(2): 121-124.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision

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