-

Öz

AMAÇ
Asetabular kemik yetmezliği ve asetabular komponent gevşemesi olan hastalardaki asetabular revizyonlarda, Asetabular Çatı halkası (AÇH) ve Burch-Schneider antiprotrusyo kafes (BSAPC) uygulamalarının orta ve uzun dönem sonuçları araştırıldı.
ÇALIŞMA PLANI
1988-2007 yılları arasında 51 hastaya 33 AÇH (25 kadın; ortalama yaş 64,9) ve 18 BSAPC (16 kadın; ortalama yaş 62,1) uygulandı. Tüm revizyonlarda greft kullanıldı. Bu hastalar retrospektif olarak incelendi. Kemik defektleri Amerikan Ortopedi Cerrahları Akademisi sınıflamasına göre tiplendirildi. Klinik değerlendirmede Harris skoru kullanıldı. Radyolojik olarak direkt grafilerde DeLee ve Charnley'e göre 3 bölgedeki radyolusent hatlar, implant bütünlükleri, osteointegrasyon ve heteretropik ossifikayon değerlendirildi.
BULGULAR
AÇH uygulamalarında ortalama 8,93±4,10 yıl (4-23) takiplerde başarı oranı %87,9 olup, 10. yıldaki kümülatif sağkalım oranı %91'dir. Harris skor ortalaması 40,10±2,49'dan ameliyat sonrası 83,70±8,98'e yükselmiştir (p<0,01). BSAPC uygulamalarında ortalama 7,06±2,39 yıl (4-12) takiplerde başarı oranı %83,3 olup 10. yıldaki kümülatif sağkalım oranı  %78'dir. Harris skor ortalaması 42,55'den ameliyat sonrası 73,86'ya yükselmiştir (p<0,01). AÇH uygulamalarındaki başarısızlıkların tamamı tip 3 defektlerde görüldü (p<0,05). Allogreft kullanılan 47 hastanın 40'ında osteointegrasyon gerçekleşti. Asetabular revizyonlarla beraber femoral komponent revizyonu geçirenlerde ve geçirmeyenlerdeki Harris skoru artışlarında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0,06). Birden fazla revizyona giren hastaların başarısızlık oranı ilk defa revizyona girenlere göre istatistiksel olarak anlamlı derecede fazla bulundu (p=0,008).
ÇIKARIMLAR
Kemik yetmezlikli asetabular revizyonlarda BSAPC ve AÇH'ların allogreftler ile kullanımının orta ve uzun dönemde sonuçları memnun edicidir. Bu implantlar greft osteointegrasyonunu sağlayarak kemik stoğunu arttırırlar ve daha sonra yapılacak revizyonları kolaylaştırırlar. Tip 1 ve tip 2 asetabular kemik defektlerinde AÇH, Tip 3 ve tip 4 defektlerde  BSAPC tercih edilmelidir.

 

DOI: 10.3944/AOTT.2015.14.0281
This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.

Anahtar Kelimeler

• Asetabular revizyonlar;Asetabular kemik yetmezliğinde asetabular revizyonlar;Asetabular Çatı Halkası;Burch-Schneider Antiprotrüzyo Kafes.

The midterm and long-term effects of acetabular roof ring and Burch-Schneider anti-protusio cages in acetabular revisions for patients with acetabular bone deficiency

Abstract

Objective: The purpose of this study was to investigate the mid-term and long-term effects of the acetabular roof ring (ARR) and Burch-Schneider anti-protrusio cage (BSAPC) in acetabular revision for patients with acetabular bone deficiency and acetabular component loosening.
Methods: Between 1988 and 2007, ARR revisions were performed in 51 patients (25 women; average age: 46.9 years) and BSAPC in 18 patients (16 women; average age: 62.1 years). Grafts were used in all revisions. The patients were evaluated retrospectively. The bone defects were classified according to the classification of the American Academy of Orthopaedic Surgeons (AAOS). Harris Hip Score (HHS) was used for clinical evaluation. Radiolucent lines, implant sizes, osseointegration, and heterotopic ossification in the 3 regions defined by DeLee and Charnley were evaluated radiologically.
Results: The success rate of ARR revisions after an average follow-up of 8.93±4.10 years (range: 4–23 years) was 87.9%, and the cumulative survival rate at year 10 postoperatively was 91%. Average HHS score increased to 83.70±8.98 postoperatively, from 40.10±2.49 preoperatively (p<0.01). The success rate of BSAPC revisions after an average follow-up of 7.06±2.39 years (range: 4–12 years) was 83.3%, and the cumulative survival rate was 78%. Average HHS score increased from 42.55 preoperatively to 73.86 postoperatively (p<0.01). All failures of ARR revisions occurred in type 3 defects (p<0.05). In 40 of the 47 patients in which an allograft was used, osseointegration occurred. No statistically significant difference was found between the increase in HHS scores of patients who underwent femoral component revision with acetabular revision and those who did not (p=0.06). Patients who underwent more than 1 revision had statistically significantly higher failure rates in comparison to patients undergoing revision for the first time (p=0.008).
Conclusion: The mid-term and long-term results of the use of ARR and BSAPC with allografts in bone deficient acetabular revisions are satisfactory. The implants facilitate graft osseointegration, increase the bone stock, and make future revisions easier. ARR should be preferred in type 1 and type 2 acetabular bone defects, while BSAPC should be preferred in type 3 and 4 defects.

Keywords

• Acetabular revisions
• acetabular bone deficiency
• acetabular roof ring
• Burch-Schneider anti-protusio cage

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