Mid-Term Reconstruction Of Paprosky Ⅲ Type Acetabular Defect By Autogenous Iliac Bone Block Combined With Titanium Plate:Providing A Strong Initial Fixation For The Prosthesis

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（r THA）.Methods:15 patients with severe acetabular defects reconstruction utilizing autogenous iliac bone blocks combined with titanium plates,including 9 men and 6 women,with an average age of 62.27 years（range 47-78 years）,were selected from June 2012 through August 2020 from Department of Orthopaedics,The First Affilicated Hospital of Bengbu Medical College.The acetabular bone defects were classified according to Paprosky classification（Paprosky Ⅲ A 10 cases,Paprosky Ⅲ B 5 cases）.The operation time and intraoperative blood loss were recorded.Clinical manifestations and postoperative X-ray characteristics of the patients were observed,the Harris hip score（HHS）and visual analogue scale（VAS）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 the CE Angle Sharp Angle of the acetabulum were measured one week after surgery and at the last follow-up,and the incidence of postoperative complications was observed.Results:All of the patients were successfully operated.The mean operation time and the mean intraoperative blood loss was（148.78±7.65）min and（522.67±198.37）ml,respectively.The average follow-up period from first to last visit was（32.76±17.52）months,ranging from 12 to 60 months.The HHS before surgery and at the last visit was（35.00±4.07）and（86.07±2.46）respectively,and the difference was statistically significant（P<0.05）.The VAS score before surgery and at the last follow-up visit was（5.80 ± 0.88）and（0.97 ± 0.55）respectively,and the difference was statistically significant（P<0.05）.The anteversion angle and abduction angle of the acetabular cup were(16.96±0.76 degrees and（41.64±0.81）degrees,respectively,both of which were within the safety range.One week post surgery,the CE angle and SHARP angle were（33.29 ± 1.49）degrees and（36.07 ± 1.70）degrees respectively.At the last follow-up visit,the CE angle and SHARP angle were（33.11 ± 1.36）degrees and（36.21 ± 1.66）degrees respectively,with no statistical significance.In this study,nervus cutaneus femoris lateralis injury appeared in one of all the patients,without occurrence of fracture of steel plate,osteolysis,infection and periprosthesis fracture.Conclusion:For patients with severe acetabular bone defects,Acetabular ring was 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.