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2022, Vol. 26 ›› Issue (9): 1424-1428Reconstruction of Paprosky III type acetabular defect by autogenous iliac bone block combined with titanium plate: providing a strong initial fixation for the prosthesisXue Yadong1, Zhou Xinshe1, Pei Lijia1, 2, Meng Fanyu1, Li Jian1, Wang Jinzi1
Abstract: BACKGROUND: In recent years, new progress has been made in the treatment of Paprosky III acetabular defects at home and abroad. Commonly used reconstruction methods include tantalum metal pads, acetabular strengthening cups-reinforcing rings, cemented acetabular prostheses, reconstruction steel plates, and titanium metal mesh. OBJECTIVE: To investigate the clinical efficacy of using autogenous iliac bone blocks in combination with titanium plate to reconstruct Paprosky III type of acetabular defects in revision total hip arthroplasty. METHODS: Totally 15 patients with severe acetabular defects reconstruction utilizing autogenous iliac bone blocks combined with titanium plates, including 9 men and 6 women, with age of 47-78 years, were selected from June 2012 to August 2020 from First Affiliated Hospital of Bengbu Medical College. Clinical manifestations and postoperative X-ray characteristics of the patients were observed. The Harris hip score and visual analogue scale score prior to operation and at the last follow-up visit were evaluated. The anteverted angle and abduction angle of the postoperative acetabular cup were recorded. The changes of center-edge angle of hip joint and acetabular angle were measured 1 week after surgery and at the last follow-up. The incidence of postoperative complications was observed. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College. RESULTS AND CONCLUSION: (1) All of the 15 patients were successfully operated and followed up for 12 to 60 months. Among them, one case had symptoms of lateral femoral cutaneous nerve injury, but no plate fracture, osteolysis, infection, or periprosthetic fracture occurred. (2) Harris hip score and visual analogue scale score were significantly improved during the last follow-up in 15 patients (P < 0.05). (3) The anteversion angle and abduction angle of the acetabular cup were (16.96±0.76)° and (41.64±0.81)°, respectively, both of which were within the safety range in 15 patients. One week post surgery and at the last follow-up, the center-edge angle and acetabular angle were not significantly different in 15 patients (P > 0.05). (4) It is concluded that for patients with Paprosky III acetabular bone defects, acetabular ring reconstructed by autogenous iliac bone and allogeneic grain bone combined with titanium plate can restore anatomic structure of the hip joint, which provides a strong initial fixation for the prosthesis, finally obtaining satisfactory clinical outcomes. Key words:revision of hip joint, autogenous iliac bone mass, titanium plate, bone defect, acetabulum reconstruction, allogeneic bone granules, acetabulum ring |