Acetabular Revision Arthroplasty Based On 3-Dimensional Reconstruction Technology Using Jumbo Cups

ObjectiveThis study was aimed at evaluating the changes of cup coverage(CC),vertical and horizontal center of rotation(V-COR,H-COR)of the hip after Jumbo cup use in different severity of acetabular bone defects compared with preoperative and healthy side.To evaluate the applicability of the Jumbo cup technique in acetabular revision.MethodsAccording to the inclusion and exclusion criteria,60 patients who sought treatment in our hospital after the initial total hip arthroplasty failure were included between September 2017 to October 2022.The Paprosky classification of these patients was as follows: 20 patients,Paprosky I;20 patients,Paprosky Ⅱ;and 20 patients,Paprosky Ⅲ.Forty healthy hips in 20 patients were matched according to sex ratio and age distribution as controls.A total of 80 CT images of the pelvis were included and saved in DICOM format.The pelvis was separated using medical image segmentation software(Mimics Research 21.0).A threedimensional implant simulation technique was used to visualize the placement of jumbo cups during acetabular revision.The acetabular anteversion,inclination,CC,and the HCOR were measured.The acetabular anteversion,inclination,CC,V-COR and H-COR were measured.And compare the change of the above data with the preoperative and healthy side.Results1.The inclination and anteversion of simulated acetabular cups in Paprosky I-Ⅲ groups were consistent with the normal acetabular anatomy.2.For changes in postoperative versus preoperative,V-COR was significantly lower in the experimental group compared to the control group(1.69 ± 0.83 mm vs.-2.13 ± 4.07 mm;p < 0.001),V-COR decreased by 2.13 mm on average.In terms of H-COR,the difference between the experimental group and the control group was statistically significant(-4.74 ± 1.05 mm vs.0.84 ± 3.26 mm;p < 0.001),the H-COR in the experimental group moved laterally by 0.84 mm on average.3.For changes in postoperative versus healthy side,V-COR was significantly higher in the experimental group compared to the control group(1.69 ± 0.87 mm vs.6.07 ± 4.99 mm;p < 0.001),V-COR increased by 2.13 mm on average.V-COR was significantly higher in the Paprosky III group than in the Paprosky I(p < 0.001)and Paprosky II groups(p = 0.001).In terms of H-COR,the postoperative H-COR in the experimental group was shifted inward by an average of 3.35 mm compared to the healthy side.The difference between experimental group and control group was statistically significant(p < 0.05).4.In terms of CC,acetabular revision using the Jumbo cup technique would decrease the CC in Paprosky I-III patients to 89.96,85.64,and 80.35%,respectively.5.Based on the bone defect map,for Paprosky I group undergoing acetabular revision with a jumbo cup,the location of missing bone contact was mainly concentrated in the anterior wall,superior wall,and the bottom of acetabulum.For Paprosky Ⅱ group,the results showed that the location of the bone defect was mainly concentrated in the anterior wall,posterosuperior wall,and the bottom of the acetabulum.For Paprosky Ⅲ group,it was mainly concentrated in the posterosuperior,posterior wall and the bottom of the acetabulum.ConclusionIn conclusion,the Jumbo cup technique is a recommended method for acetabular revision,although the use of Jumbo cups in Paprosky I-III patients decreases the initial CC and increases the severity of acetabular bone defects,the CC is consistently > 70%.In addition,the Jumbo cup technique decreases V-COR and shifts H-COR externally to bring COR closer to the anatomic position,but it is associated with a significant elevation of V-COR in Paprosky III patients compared to the healthy side.This information may alert the surgeon to the need for additional procedures to compensate for excessive elevation of V-COR when using the Jumbo cup.