Bone remodeling after revision total hip arthroplasty for large acetabular defects.

Autor: Ramesh A; Department of Mechanical Engineering, University College London, London, UK., Di Laura A; Department of Mechanical Engineering, University College London, London, UK.; Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK., De Angelis S; Department of Mechanical Engineering, University College London, London, UK., Henckel J; Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK., Hart A; Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.; Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.; Cleveland Clinic London, London, UK.
Jazyk: angličtina
Zdroj: Journal of orthopaedic research : official publication of the Orthopaedic Research Society [J Orthop Res] 2024 Dec; Vol. 42 (12), pp. 2784-2795. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1002/jor.25936
Abstrakt: Large acetabular bone defects are challenging in hip revision surgery. Clinical assessment is crucial to evaluate modern technologies in surgical reconstruction. We aimed to better understand the bone remodeling that occurs following acetabular reconstruction. Our objectives were: (1) To characterize changes in the shape of the pelvis by studying sequential computed tomography (CT) scans collected immediately and 1-year postoperatively and (2) to identify which part of the pelvis is most susceptible to remodeling. We used the CT scans taken at two timepoints, of 24 patients with acetabular bone defects classified as Paprosky IIIB, treated with three-dimensional (3D)-printed custom-made acetabular implants. Segmented 3D models of the bony pelvis were co-registered using three different techniques. A global co-registration of the full pelvis was conducted, followed by the co-registration of the innominate bone and then ilium only, on the ipsilateral reconstructed side. The relative movements of the ilium, ischium, and pubis were analyzed from visual inspection and using co-registration metrics (root mean square error and intersection over union). No bone remodeling was found in 14/24 patients (58%). The co-registration of the innominate bone indicated bone remodeling in five cases (21%), while the remaining five cases (21%) presented remodeling in the global co-registration but not the innominate bone co-registration, suggestive of changes occurring at the sacroiliac joint. Changes in the pelvic shape were greatest at the pubis and ischium. Bone remodeling may occur in complex cases of Paprosky type IIIB defects, after acetabular reconstruction (occurrence of 21%, 5/24 cases). Surgeons and engineers should consider this when monitoring implant migration.
(© 2024 The Author(s). Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)
Databáze: MEDLINE
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