A porous tantalum uncemented acetabular cup in acetabular revision arthroplasty
10.3969/j.issn.1673-8225.2009.17.033
- VernacularTitle:生物学固定骨小梁金属杯在髋臼翻修中的应用
- Author:
Weidong XU
;
Gang CHEN
;
Donghua ZHANG
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2009;13(17):3352-3356
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: Biological fixation refers to the treatment of coarse or porous prosthetic surface. It is favorable to "bone ingrowth" prosthesis to achieve long-term stability. Porous tantalum is the latest scientific product that appears suitable to prosthetic surface owing to its porous feature and has been attracting a great deal attention.OBJECTIVE: To investigate the therapeutic efficacy of a porous tantalum uncemented acetabular cup in acetabular revision arthroplasty.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA between April and November 2006.PARTICIPANTS/MATERIALS: Sixteen patients (16 hips), 7 males and 9 females, aged 54-81 years old, who received treatment at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA were included in this study. Of these patients, 2 suffered from femoral neck fracture, 6 from aseptic femoral head necrosis, and 8 from osteoarthritis. Trabecular metal cup (Zimmer, Warsaw, Indiana) provided a titanium alloy bottom layer and porous tantalum-coated surface, which was realized by technical combination of bone trabecular tantalum and titanium alloy. The prosthesis contained an ultrahigh modulus polyethylene lining.METHODS: All patients underwent acetabular revision with modular porous tantalum uncemented acetabular cup. Prior to replacement, acetabular defects and femoral prosthesis were evaluated. A posterolateral approach of hip joint was made. Following acatabular prosthesis removal, bone cement was cleared with osteotome, simultaneously scar tissue, granulation tissue, and fibrous limiting membrane in the acetabular fossa were erased with curette to avoid further damage to sclerotin. Bacteriological examination and susceptibility test with respect to intraarticular tissue fluid confirmed aseptic loosening. Antibiotics were used in each patient to prevent infection. Antibiotics and low molecular heparin were used afterwards to prevent infection and thromboembolism, respectively. Patients could not load within 4 weeks but could walk with the aid of two canes within subsequent 6 weeks. One week after surgery, plain X-ray films were taken in the lateral plane.MAIN OUTCOME MEASURES: Prior to and 6, 12, and 24 months after surgery, Harris hip score and University of California Los Angeles (UCLA) activity score were assessed. The position of acetabular prosthesis was observed through an anteropostedor pelvic radiograph.RESULTS: The average follow-up time was 24 months (range 18-25 months). Harris hip score significantly increased from 32.6 points (range 21-54 points) prior to revision to 87.5 points (range 56-90 points) after revision (P < 0.05). UCLA activity score significantly increased from 3.8 points (2-5 points) prior to revision to 8.2 points (range 6-9 points) after revision (P<0.05). The anteropostedor pelvic radiographs taken in the last follow-up displayed no phenomena regarding non-stability including prosthesis aversion and subsidence and revealed that the in-growth of sclerotin surrounding the bone trabecular tantalum acetabular cup. Postoperative complications were found in none of 16 patients. By the last follow-up, there had been 14 cases who did not complain of pains while walking and 2 cases that had slight pain and slight limp while walking. Deep venous thrombosis or nerve injury did not appear afterwards. No cases needed another acetabular revision arthroplasty.CONCLUSION: For cases of failed primary fixation of artificial acetabular cup, application of porous tantalum uncemented acetabular cup can produces favorable results in acetabular revision if no bone defects exist.
