Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing techn...Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.展开更多
Summary： This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients...Summary： This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients （involving 236 hips） with Paprosky III and 1V femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug. 2006. Impaction bone graft technique was used for 112 hips, with allogeneic freeze-dried bone as bone graft and SP II as prosthesis. With 124 hips, modular distal press-fit fixation and tapered femoral stem （MP stem） were employed. After the operation, the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score （HHS） and 12-item Short Form Health Survey （SF-12）. Radiolucence, subsidence and loosening were observed and complications, including infection, fracture, dislocation etc. were recorded. A 6-14-year follow-up showed that prostheses failed, due to infection, in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure, with the survival rates for the two techniques being 96.43% and 95.16%, respectively. One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications （P〈0.05） and was not related to the type of the bone defects （P〉0.05）. The rate of complications bore significant association with the type of bone defects in the two groups （P〈0.05）. Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects. It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect. Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.展开更多
BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis ...BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare.CASE SUMMARY Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect(Parprosky IIIB type), and a bone defect of the left proximal femur(Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3Dprinted custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90.CONCLUSION The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.展开更多
BACKGROUND Both periprosthetic joint infections(PJIs)and severe femoral segmental defects are catastrophic complications of total hip arthroplasty(THA),and both present a significant challenge in revisional surgery.Th...BACKGROUND Both periprosthetic joint infections(PJIs)and severe femoral segmental defects are catastrophic complications of total hip arthroplasty(THA),and both present a significant challenge in revisional surgery.There are limited data available to guide clinical decision making when both occur concurrently.CASE SUMMARY A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision.Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect.Based on histological,radiological,laboratory,and clinical features,a diagnosis of concurrent chronic PJI and segmental femoral defect(Type IIIB,Paprosky classification)was made.After multidisciplinary team discussion,three-dimensional(3D)-printed,custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer.These were placed following PJI debridement in the first stage of revision surgery.After the PJI was eliminated,a 3D-printed,custom-made,femoral prosthesis was created to repair the considerable femoral defect.After 20-mo follow-up,the patient had excellent functional outcomes with a near-normal range of hip movement.So far,neither evidence of recurrent infection nor loosening of the prosthesis has been observed.CONCLUSION We describe a case of“two-stage,custom-made”total hip revision to treat PJI with a concurrent segmental femoral defect.Use of a personalized,3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications.Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available.However,the long-term function,longevity,and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored.展开更多
Revision total hip arthroplasty(THA)with massive bone loss has been a real challenge for orthopaedic surgeons.Here we describe an approach using mineralized collagen(MC)graft to reconstruct acetabulum and femur with m...Revision total hip arthroplasty(THA)with massive bone loss has been a real challenge for orthopaedic surgeons.Here we describe an approach using mineralized collagen(MC)graft to reconstruct acetabulum and femur with massive bone defects.We identified 89 patients suffering acetabular or femoral bone defects after primary THA,who required revision THA for this study.During the surgery,MC was applied to reconstruct both the acetabular and femoral defects.Harris hip score was used to evaluate hip function while radiographs were taken to estimate bone formation in the defect regions.The average follow-up period was 33.662.4 months.None of the components needed re-revised.Mean Harris hip scores were 42.563.5 before operation,75.264.0 at 10th month and 95.063.6 at the final follow-up.There were no instances of deep infection,severe venous thrombosis or nerve palsy.The present study demonstrated that MC graft can serve as a promising option for revision THA with massive bone deficiency.Meanwhile,extended follow-up is needed to further prove its long-term performance.展开更多
The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was ...The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.展开更多
目的评估利用“双杯”技术(去除钛环的钽金属翻修臼杯作为增强块)治疗PaproskyⅢ型髋臼缺损的早期临床效果。方法回顾性地分析评估了2017—2023年在中国科学技术大学附属第一医院(安徽省立医院)接受“双杯”技术进行治疗的54例全髋关节...目的评估利用“双杯”技术(去除钛环的钽金属翻修臼杯作为增强块)治疗PaproskyⅢ型髋臼缺损的早期临床效果。方法回顾性地分析评估了2017—2023年在中国科学技术大学附属第一医院(安徽省立医院)接受“双杯”技术进行治疗的54例全髋关节翻修术病例。其中男女性患者数量一致,均为27例,年龄30~92岁,平均年龄(65.8±12.3)岁。通过记录患者术前和末次随访时Harris髋关节评分、Oxford髋关节评分和36项健康调查简表(36-item short form survey,SF-36)功能评分来评估临床功能结果;对术前、术后髋关节旋转中心位置和双下肢长度差在影像学上进行评估;评估有无假体松动等术后并发症的发生。结果54例患者均获随访,随访时间为8~80个月,平均(35.3±20.9)个月。术前Harris髋关节评分、Oxford髋关节评分和SF-36功能评分分别为(35.6±10.5)分、(24.4±7.1)分和(805.7±47.5)分,末次随访时分别为(90.6±11.5)分、(44.0±4.2)分和(859.4±47.4)分,患者临床功能结果得到显著改善(P<0.001)。此外,末次随访的影像学结果显示,无论是髋关节旋转中心位置还是双下肢长度差与术前相比都有明显改善(P<0.001),实现了良好的生物力学重建。术后无假体周围感染,6例患者发生假体脱位,但只有1例患者在随访中因假体反复脱位进行了二次手术。结论“双杯”技术是进行PaproskyⅢA和ⅢB型严重髋臼缺损重建的可靠选择,其并发症少、安全性高、功能恢复好,值得在临床上大力推广。展开更多
基金This work is supported by National Key Research and Development Program of China(2016YFC1100600)the National Natural Science Foundation of China(81972058 and 81902194)the Multicenter Clinical Research Project of Shanghai Jiao Tong University School of Medicine(DLY201506).
文摘Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.
基金supported by a grant from the National High Technology Research and Development Program of China(863 Program)(NO.2011AA030101)
文摘Summary： This study evaluated the clinical effect of impaction bone graft and distal press-fit fixation for the reconstruction of severe femoral bone defect in revision total hip arthroplasty. A total of 234 patients （involving 236 hips） with Paprosky III and 1V femoral bone defects were treated with the revision total hip arthroplasty from June 1998 to Aug. 2006. Impaction bone graft technique was used for 112 hips, with allogeneic freeze-dried bone as bone graft and SP II as prosthesis. With 124 hips, modular distal press-fit fixation and tapered femoral stem （MP stem） were employed. After the operation, the subjects were followed up on regular basis and results were assessed by using the Harris Hip Score （HHS） and 12-item Short Form Health Survey （SF-12）. Radiolucence, subsidence and loosening were observed and complications, including infection, fracture, dislocation etc. were recorded. A 6-14-year follow-up showed that prostheses failed, due to infection, in 4 patients of impaction bone graft group and that 6 patients in the press-fit fixation group experienced prosthesis failure, with the survival rates for the two techniques being 96.43% and 95.16%, respectively. One-way ANOVA showed that prosthesis survival was significantly associated with surgery-related complications （P〈0.05） and was not related to the type of the bone defects （P〉0.05）. The rate of complications bore significant association with the type of bone defects in the two groups （P〈0.05）. Our study showed that the two revision methods could achieve satisfactory mid-term and long-term results for the reconstruction of severe bone defects. It is of great significance for attaining high prosthesis survival rate to select suitable operation on the basis of the type of bone defect. Careful operative manipulation and post-operative rehabilitation aimed at reducing complications are also important.
文摘BACKGROUND Hip revision surgery is the final treatment option for the failure of artificial hip joints, but it is more difficult than the initial operation. For patients with hip joint loosening around the prosthesis combined with large inflammatory pseudotumours and large segment bone defects, hip revision is even more difficult, and clinical reports are rare.CASE SUMMARY Male, 59 years old. The patient underwent left hip replacement 35 years ago and was now admitted to hospital due to massive masses in the left thigh, shortening of the left lower extremity, and pain and lameness of the left hip joint. X-ray, computed tomography and magnetic resonance imaging revealed prosthesis loosening, left acetabular bone defect(Parprosky IIIB type), and a bone defect of the left proximal femur(Parprosky IIIA type). Inflammatory pseudotumours were seen in the left hip and left thigh. Hip revision surgery was performed using a 3Dprinted custom acetabular prosthesis was used for hip revision surgery, which was produced by Arcam Electron Beam Melting system with Electron Beam Melting technology. The operation was successful, and the patient was followed up regularly after the operation. The custom-made acetabular prosthesis was well matched, the inflammatory pseudotumour was completely removed, the postoperative hip prosthesis was stable, and the old greater trochanter fracture was well reduced and fixed. The patient was partially weight-bearing with crutches 3 mo after the operation and walked with full weight-bearing after 6 mo. The hip prosthesis was stable, and there was no recurrence of inflammatory pseudotumours at the last follow-up. The Visual Analogue Scale was 3, and the Harris hip score was 90.CONCLUSION The use of 3D-printed personalized custom prostheses for complex hip revision surgery has satisfactory surgical results and has great clinical application value.
文摘BACKGROUND Both periprosthetic joint infections(PJIs)and severe femoral segmental defects are catastrophic complications of total hip arthroplasty(THA),and both present a significant challenge in revisional surgery.There are limited data available to guide clinical decision making when both occur concurrently.CASE SUMMARY A 61-year-old woman presented with a 6-mo history of a sinus tract at the site of her original THA incision.Radiological imaging revealed a total hip joint implant with an ipsilateral segmental femoral defect.Based on histological,radiological,laboratory,and clinical features,a diagnosis of concurrent chronic PJI and segmental femoral defect(Type IIIB,Paprosky classification)was made.After multidisciplinary team discussion,three-dimensional(3D)-printed,custom-made antibiotic spacers were created that could be used to mold antibiotic-loaded cement spacer.These were placed following PJI debridement in the first stage of revision surgery.After the PJI was eliminated,a 3D-printed,custom-made,femoral prosthesis was created to repair the considerable femoral defect.After 20-mo follow-up,the patient had excellent functional outcomes with a near-normal range of hip movement.So far,neither evidence of recurrent infection nor loosening of the prosthesis has been observed.CONCLUSION We describe a case of“two-stage,custom-made”total hip revision to treat PJI with a concurrent segmental femoral defect.Use of a personalized,3D-printed spacer and proximal femoral prosthesis led to satisfactory hip function and no early postoperative complications.Use of a customized implant provides surgeons with an alternative option for patients where no suitable spacer or implant is available.However,the long-term function,longevity,and cost-effectiveness of the use of custom-made prostheses have yet to be fully explored.
基金This work was partly supported by National Basic Research Program(973 Program)of China(2011CB606205)‘Twelfth Five-Year’National Science and Technology Support Program(2012BAI17B02)funded by the Ministry of Science and Technology of China,and the National Natural Science Foundation of China(21371106,51402167)Shandong province science and technology development program(2013GGA10036).Conflict of interest statement.None declared.
文摘Revision total hip arthroplasty(THA)with massive bone loss has been a real challenge for orthopaedic surgeons.Here we describe an approach using mineralized collagen(MC)graft to reconstruct acetabulum and femur with massive bone defects.We identified 89 patients suffering acetabular or femoral bone defects after primary THA,who required revision THA for this study.During the surgery,MC was applied to reconstruct both the acetabular and femoral defects.Harris hip score was used to evaluate hip function while radiographs were taken to estimate bone formation in the defect regions.The average follow-up period was 33.662.4 months.None of the components needed re-revised.Mean Harris hip scores were 42.563.5 before operation,75.264.0 at 10th month and 95.063.6 at the final follow-up.There were no instances of deep infection,severe venous thrombosis or nerve palsy.The present study demonstrated that MC graft can serve as a promising option for revision THA with massive bone deficiency.Meanwhile,extended follow-up is needed to further prove its long-term performance.
基金supported and funded by the following grants:National Natural Science Foundation of China[Grant Numbers 82072456 and 81802174]National Key R&D Program of China[Grant Number.2018YFB1105100]+7 种基金Bethune plan of Jilin University[Grant Number 419161900014]Wu Jieping Medical Foundation[3R119C073429]Department of Science and Technology of Jilin Province,P.R.C.[Grant Numbers 20200404202YY and 20200201453JC]Department of Finance in Jilin province[Grant Numbers 2019SCZT046,2020SCZT037]undergraduate teaching reform research project of Jilin University[Grant Number 4Z2000610852]key training plan for outstanding young teachers of Jilin University[Grant Number 419080520253]Jilin Province Development and Reform Commission,P.R.C.[Grant Number 2018C010]Natural Science Foundation of Jilin Province[Grant Number 20200201345JC].
文摘The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.
文摘目的评估利用“双杯”技术(去除钛环的钽金属翻修臼杯作为增强块)治疗PaproskyⅢ型髋臼缺损的早期临床效果。方法回顾性地分析评估了2017—2023年在中国科学技术大学附属第一医院(安徽省立医院)接受“双杯”技术进行治疗的54例全髋关节翻修术病例。其中男女性患者数量一致,均为27例,年龄30~92岁,平均年龄(65.8±12.3)岁。通过记录患者术前和末次随访时Harris髋关节评分、Oxford髋关节评分和36项健康调查简表(36-item short form survey,SF-36)功能评分来评估临床功能结果;对术前、术后髋关节旋转中心位置和双下肢长度差在影像学上进行评估;评估有无假体松动等术后并发症的发生。结果54例患者均获随访,随访时间为8~80个月,平均(35.3±20.9)个月。术前Harris髋关节评分、Oxford髋关节评分和SF-36功能评分分别为(35.6±10.5)分、(24.4±7.1)分和(805.7±47.5)分,末次随访时分别为(90.6±11.5)分、(44.0±4.2)分和(859.4±47.4)分,患者临床功能结果得到显著改善(P<0.001)。此外,末次随访的影像学结果显示,无论是髋关节旋转中心位置还是双下肢长度差与术前相比都有明显改善(P<0.001),实现了良好的生物力学重建。术后无假体周围感染,6例患者发生假体脱位,但只有1例患者在随访中因假体反复脱位进行了二次手术。结论“双杯”技术是进行PaproskyⅢA和ⅢB型严重髋臼缺损重建的可靠选择,其并发症少、安全性高、功能恢复好,值得在临床上大力推广。
