BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the h...BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the hip joint may become elevated relative to the primary acetabulum,and the diameter of the large cup is greater.AIM To study the height and the significance of the elevation of the hip joint center.METHODS Eighty-eight patients matched the criteria for this condition and were included in the study.The center height of the hip joint was measured relative to the opposite normal hip joint.The diameter of the jumbo cup was measured and checked according to operation notes,and the diameter of the jumbo cup was measured with a prosthesis label.Then,the horizontal and vertical centers of rotation were measured on the surgical side and opposite side.The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm.The rotational center height delta of the renovated hip was 7.6±5.6 mm,and there was an obvious difference between the two groups(P=0.00).The difference in horizontal distance was 0.5±5.1 mm(-11.5-14.0 mm),and there was no obvious difference between the two groups(P=0.38).According to the foreign standard,the rotational center height delta of the renovated hip was 7.5±6.2 mm,and there was a significant difference between the two groups(P=0.00).There was no obvious difference between the domestic and foreign standards(P>0.05)between the two groups.CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint,but it is feasible and effective to use the jumbo cup.展开更多
The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone ...The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.展开更多
目的探讨应用大号生物型臼杯(Jumbo臼杯)行髋关节翻修术后髋关节旋转中心(hip center of rotation,COR)和股骨偏心距的变化。方法回顾性分析2010年1月—2015年5月应用Jumbo臼杯行髋关节翻修术的23例患者临床资料,其中8例联合颗粒骨植骨...目的探讨应用大号生物型臼杯(Jumbo臼杯)行髋关节翻修术后髋关节旋转中心(hip center of rotation,COR)和股骨偏心距的变化。方法回顾性分析2010年1月—2015年5月应用Jumbo臼杯行髋关节翻修术的23例患者临床资料,其中8例联合颗粒骨植骨,10例联合颗粒骨植骨并结构性植骨。男10例,女13例;年龄51~77岁,平均65.4岁。初次人工全髋关节置换术至翻修术间隔1~24年,平均8.57年。髋关节翻修原因:无菌性松动21例,假体周围感染2例。患者Harris评分为(43.04±5.05)分,疼痛视觉模拟评分(VAS)为(5.70±0.97)分。骨缺损根据Paprosky分型标准,Ⅰ型5例,ⅡA型5例,ⅡB型3例,ⅡC型6例,ⅢA型4例。双髋X线片测量示,健侧股骨偏心距为(40.65±4.09)mm,患侧为(44.04±5.08)mm,比较差异有统计学意义(t=4.098,P=0.000);10例(43.48%)股骨偏心距重建,13例(56.52%)未重建;10例(43.48%)COR重建,11例(47.83%)COR上移,2例(8.69%)COR下移。结果术后切口均Ⅰ期愈合,无感染、血管损伤、下肢深静脉血栓形成、关节脱位、假体周围骨折等并发症发生。患者均获随访,随访时间12~76个月,平均22.48个月。术后1年Harris评分为(82.09±4.53)分,VAS评分为(0.74±0.62)分,与术前比较差异均有统计学意义(t=37.831,P=0.000;t=22.318,P=0.000)。X线片复查示,翻修术后1年患侧股骨偏心距为(43.87±3.57)mm,与术前比较差异无统计学意义(t=0.250,P=0.805),与健侧比较差异有统计学意义(t=5.591,P=0.000)。翻修术后患侧股骨偏心距重建16例(69.57%),未重建7例(30.43%);15例(65.22%)COR重建,8例(34.78%)COR上移。结论单纯应用Jumbo臼杯行髋关节翻修术可能导致COR上移和股骨偏心距增加。合理安放Jumbo臼杯以及正确处理髋臼骨缺损,能够最大限度恢复COR和股骨偏心距,获得良好近期疗效,假体稳定性可。展开更多
文摘BACKGROUND Utilizing the large jumbo cup in revision total hip arthroplasty is an effective approach to cure many lacunar and segmental peripheral bone defects.However,with the use of the jumbo cup,the center of the hip joint may become elevated relative to the primary acetabulum,and the diameter of the large cup is greater.AIM To study the height and the significance of the elevation of the hip joint center.METHODS Eighty-eight patients matched the criteria for this condition and were included in the study.The center height of the hip joint was measured relative to the opposite normal hip joint.The diameter of the jumbo cup was measured and checked according to operation notes,and the diameter of the jumbo cup was measured with a prosthesis label.Then,the horizontal and vertical centers of rotation were measured on the surgical side and opposite side.The average center height of the hip joint on the renovated side and the opposite side and the position of the hip cup relative to the teardrop were compared using a paired t-test.RESULTS Radiometric analysis showed that the average hip joint center was elevated by 7.6 mm.The rotational center height delta of the renovated hip was 7.6±5.6 mm,and there was an obvious difference between the two groups(P=0.00).The difference in horizontal distance was 0.5±5.1 mm(-11.5-14.0 mm),and there was no obvious difference between the two groups(P=0.38).According to the foreign standard,the rotational center height delta of the renovated hip was 7.5±6.2 mm,and there was a significant difference between the two groups(P=0.00).There was no obvious difference between the domestic and foreign standards(P>0.05)between the two groups.CONCLUSION The application of the jumbo cup elevates the rotational center of the hip joint,but it is feasible and effective to use the jumbo cup.
基金This work was supported by funding from China Postdoctoral Science Foundation(No:2020M670863)Jilin Scientific and Technological Development Program(No:20230203089SF).
文摘The biomechanical effects of acetabular revision with jumbo cups are unclear.This study aimed to compare the biomechanical effects of bionic trabecular metal vs.titanium jumbo cups for the revision of acetabular bone defects.We designed and reconstructed American Academy of Orthopaedic Surgeons(AAOS)type I–III acetabular bone defect models using computed tomography scans of a man without acetabular bone defects.The implantation of titanium and trabecular metal jumbo cups was simulated.Stress distribution and relative micromotion between the cup and host bone were assessed using finite element analysis.Contact stress on the screws fixing the cups was also analyzed.The contact stress analysis showed that the peak contact stress between the titanium jumbo cup and the host bone was 21.7,20.1,and 23.8 MPa in the AAOS I–III models,respectively;the corresponding values for bionic tantalum jumbo cups decreased to 4.7,6.7,and 11.1 MPa.Analysis of the relative micromotion showed that the peak relative micromotion between the host bone and the titanium metal cup was 10.2,9.1,and 11.5μm in the AAOS I–III models,respectively;the corresponding values for bionic trabecular metal cups were 17.2,18.2,and 31.3μm.The peak contact stress on the screws was similar for the 2 cup types,and was concentrated on the screw rods.Hence,acetabular reconstruction with jumbo cups is biomechanically feasible.We recommend trabecular metal cups due to their superior stress distribution and higher relative micromotion,which is within the threshold for adequate bone ingrowth.
文摘目的探讨应用大号生物型臼杯(Jumbo臼杯)行髋关节翻修术后髋关节旋转中心(hip center of rotation,COR)和股骨偏心距的变化。方法回顾性分析2010年1月—2015年5月应用Jumbo臼杯行髋关节翻修术的23例患者临床资料,其中8例联合颗粒骨植骨,10例联合颗粒骨植骨并结构性植骨。男10例,女13例;年龄51~77岁,平均65.4岁。初次人工全髋关节置换术至翻修术间隔1~24年,平均8.57年。髋关节翻修原因:无菌性松动21例,假体周围感染2例。患者Harris评分为(43.04±5.05)分,疼痛视觉模拟评分(VAS)为(5.70±0.97)分。骨缺损根据Paprosky分型标准,Ⅰ型5例,ⅡA型5例,ⅡB型3例,ⅡC型6例,ⅢA型4例。双髋X线片测量示,健侧股骨偏心距为(40.65±4.09)mm,患侧为(44.04±5.08)mm,比较差异有统计学意义(t=4.098,P=0.000);10例(43.48%)股骨偏心距重建,13例(56.52%)未重建;10例(43.48%)COR重建,11例(47.83%)COR上移,2例(8.69%)COR下移。结果术后切口均Ⅰ期愈合,无感染、血管损伤、下肢深静脉血栓形成、关节脱位、假体周围骨折等并发症发生。患者均获随访,随访时间12~76个月,平均22.48个月。术后1年Harris评分为(82.09±4.53)分,VAS评分为(0.74±0.62)分,与术前比较差异均有统计学意义(t=37.831,P=0.000;t=22.318,P=0.000)。X线片复查示,翻修术后1年患侧股骨偏心距为(43.87±3.57)mm,与术前比较差异无统计学意义(t=0.250,P=0.805),与健侧比较差异有统计学意义(t=5.591,P=0.000)。翻修术后患侧股骨偏心距重建16例(69.57%),未重建7例(30.43%);15例(65.22%)COR重建,8例(34.78%)COR上移。结论单纯应用Jumbo臼杯行髋关节翻修术可能导致COR上移和股骨偏心距增加。合理安放Jumbo臼杯以及正确处理髋臼骨缺损,能够最大限度恢复COR和股骨偏心距,获得良好近期疗效,假体稳定性可。
