Application of jumbo cups for acetabular deficiencies in hip revision procedures used in acetabulum defects of the hip revision procedures
WANG Bei-yue
ZHOU Li-wu
ZHANG Zhi-qiang
GUO Ting
ZHAO Jian-ning
Abstract：Objective To investigate the application of jumbo acetabular cups for Paprosky type II and type III A acetabular deifciencies after total hip arthroplasty ( THA ).Methods The clinical data of 24 patients who were diagnosed as acetabular deifciencies of Paprosky type II or type III A after THA from March 2007 to May 2014 were retrospectively analyzed. There were 13 males and 11 females, whose average age was 61.46 years old ( range: 34-77 years ). As to the reason of acetabular revision, there were 21 cases caused by aseptic loosening, 2 cases by habitual hip dislocation and 1 case by low toxicity infection. Primary and unilateral revision was performed on all the patients. Cemented acetabular prostheses were used in 11 cases, cementless acetabular prostheses in 10 cases and artiifcaial femoral head arthrolasty in 3 cases. According to the Paprosky acetabular defect classiifcation, there were 7 hips of type II A, 6 hips of type II B, 5 hips of type II C and 6 hips of type III A. Jumbo acetabular cups or combined with bone grafts were used in acetabular revision with prostheses. For the patients with acetabular deifciencies of Paprosky type II, the acetabulum was reamed and enlarged on the premise that the stability of the prosthesis was not affected, and then morselized bone graft was performed or the acetabular prosthesis with a jumbo cup was directly put in. For the patients with acetabular deifciencies of Paprosky type III A, an appropriate amount of compacted and morselized bone graft was used. Structural bone graft or the acetabular notch sealing was carried out, so as to increase the bone mass. The implantation technique through the center of the high ball could be directly adopted, with jumbo acetabular cups embedded. The problems of the balance of both lower limbs and the eccentricity could be handled by adjusting the length of the prosthetic handle and neck. A regular follow-up was carried out after the operation. The Harris hip score and Visual Analogue Scale ( VAS ) score were used to evaluate the hip function and state. The prosthetic stability and bone union were judged based on the X-ray.Results All the patients were followed up for a mean period of 23.84 months ( range: 12-83 months ) to evaluate the hip function and the pain problem. The Harris hip scores were ( 44.92±10.53 ) points, ( 84.75±4.61 ) points and ( 88.88±5.70 ) points preoperatively and at 1 and 3 years after the operation (P<0.01 ). The VAS scores were ( 4.58±1.69 ) points, ( 0.71±0.91 ) points and ( 0.50±0.66 ) points preoperatively and at 1 and 3 years after the operation (P<0.01 ). No patient required a second revision because of the failure of prosthetic revision. The X-ray showed strong evidence of trabecular bridging between the bone graft and the host bone. The gait of the patients recovered to normal, and their walking was not affected by prosthetic dislocation or loosening or abnormal hip pain during the follow-up. At 1 year after the operation, the hip lfexion angel reached to more than 90°. And at 3 years after the operation, the patients could complete daily activities, and even jog or squat. Conclusions Jumbo acetabular cups or combined with morselized or structural bone graft are effective for Paprosky type II and type III A acetabular deifciencies after THA. The dififculty in acetabular revision can be reduced and the results are excellent, with reasonable selection of the prostheses and suitable management of acetabular deifciencies.
Keywords：Hip jointArthroplastyreplacementhipJoint prosthesisAcetabulum
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 419-423 )