Reconstruction And Short-term Clinical Effect Of Acetabular Paprosky Type Ⅲ Defect In Revision Of Total Hip Arthroplasty

Objective:To review the different reconstructive strategies of Paprosky type Ⅲ acetabular bone defects for hip revision and evaluate the short-term clinical outcomes.Methods:Eleven patients(11 hips)who underwent hip revision for any reason after total hip arthroplasty(THA)in our hospital from January 2014 to January 2020 were selected for the study,including 7 males and 4 females,6 left-sided and 5 right-sided.The average age of the patients was(63.73±16.62)years old.The interval between the initial arthroplasty and the revision surgery was(11.09±3.48)years.The reasons for hip revision surgery included aseptic loosening of the prosthesis in 7 cases,periprosthetic fracture in 3 cases,and periprosthetic infection in 1 case.The preoperative acetabular bone defects were classified into 7 cases of type ⅢA bone defects and 4 cases of type ⅢB bone defects according to Paprosky’s staging.After the operation,the stability of the prosthesis was judged based on the X-ray film,and the patients were followed up regularly.The Harris hip score(HHS)and the visual analog score(VAS)were used to assess the short-term postoperative hip function and clinical outcome.Results:All 11 patients were followed up with an average follow-up time of (35.18±10.71)months.The mean preoperative hip Harris score was(25.72±6.92)and the mean postoperative final follow-up was(83.82±6.40),of which 2 cases had excellent(90-100)scores and 6 cases had good(80-89)scores.The mean preoperative VAS score was(8.18±0.87)and the mean postoperative final follow-up was(2.81±1.08),of which 4 cases were excellent(0-2)and 7 cases were good(3-5).The Harris score and VAS score of this group of patients had significant changes in the comparison between preoperative and postoperative follow-up(P<0.05),and the difference was statistically significant.Conclusion:The management of Paprosky type Ⅲ bone defects in the acetabulum after THA is complex,and the bone defects should be accurately evaluated and adequately prepared according to the imaging presentation before surgery.In this study,appropriate reconstructive solutions were selected for different degrees of acetabular bone defects,including porous metal cups with bone graft,use of porous trabecular metal reinforcement blocks,cup-on-cup technique,etc.,and good short-term clinical outcomes were obtained through follow-up,and the quality of life of patients was improved.However,many issues need further research and follow-up analysis.