PURPOSE The acetabular reinforcement ring with a hook (ARRH) has been designed for acetabular total hip arthroplasty (THA) revision. Additionally, the ARRH offers several advantages when used as a primary implant especially in cases with altered acetabular morphology. The implant facilitates anatomic positioning by placing the hook around the teardrop and provides a homogenous base for cementing the polyethylene cup. Therefore, the implant has been widely used in primary total hip arthroplasty at our institution. The present study reports the long-term outcome of the ARRH after a minimum follow-up of 20 years. METHODS Two hundred and ten patients with 240 primary THAs performed between April 1987 and December 1991 using the ARRH were retrospectively reviewed after a minimum follow-up of 20 years. Twenty-three of 240 hips were lost to follow-up, 110 patients with 124 THAs had deceased without having a revision surgery performed. This left 93 hips for final evaluation. Of those, 75 hips were assessed clinically and radiographically after a mean follow-up of 23.1 years (range 21.1-26.1 years). In 18 cases, clinical and radiographic assessment was omitted because implant revision had been performed prior to the follow-up investigation. The primary endpoint was defined as revision for aseptic loosening. RESULTS Out of the 93 hips available for final evaluation, 14 hips were revised for aseptic loosening; another four were revised for other reasons (deep infection n = 2, recurrent dislocation n = 2). The survival probability of the cup was 0.96 (95% confidence interval 0.93-0.99) after 20 years with aseptic loosening as endpoint. Radiographic analysis of the surviving 75 hips showed at least one sign of radiographic loosening in 24 hips. The mean Merle d'Aubigne score increased from 8 points pre-operatively to 15 points at final follow-up (7.5 ± 1.8 vs 15.0 ± 2.3, p < 0.001). The mean HHS was 85 ± 14 at final follow-up. Radiographic loosening did not correlate with the clinical outcome. CONCLUSIONS The long-term results of the ARRH in primary THA are comparable to results with standard cemented cups and modern cementless cups. We believe that the ARRH is a versatile implant for primary THA, especially in cases with limited acetabular coverage and altered acetabular bone stock where the ARRH provides sufficient structural support for a cemented cup.

中文翻译：

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当作为主要植入物时，Ganz髋臼增强环显示出优异的长期效果：回顾性分析了240例主要的全髋关节置换术，至少随访了20年。

目的带钩的髋臼增强环（ARRH）设计用于髋臼全髋关节置换术（THA）翻修。此外，ARRH用作主要植入物时具有多个优点，尤其是在髋臼形态改变的情况下。植入物通过将挂钩放置在泪珠周围来促进解剖学定位，并提供了用于粘合聚乙烯杯的均质基底。因此，该植入物已在我们机构广泛用于原发性全髋关节置换术中。本研究报告了最少随访20年后ARRH的长期结果。方法1987年4月至1991年12月期间，使用ARRH进行的120例原发性THA患者共120例，至少经过20年的随访。240髋中有23髋失访，110例THA患者中有110例因未做过翻修手术而死亡。这留下了93个臀部以进行最终评估。其中，平均随访23.1年（范围21.1-26.1年）后，对75髋进行了临床和影像学评估。在18例中，由于在随访研究之前进行了植入物翻修，因此省略了临床和X线照片评估。主要终点定义为无菌性松动的修订。结果在93条可进行最终评估的髋关节中，有14髋因无菌性松动而进行了翻修。由于其他原因（深部感染n = 2，复发性脱位n = 2）对另外四个进行了修订。以无菌松动为终点的20年后，杯子的存活概率为0.96（95％置信区间为0.93-0.99）。幸存的75个髋关节的影像学分析表明，在24个髋关节中至少有一个影像学松动的迹象。平均Merle d'Aubigne评分从术前的8分提高到最终随访时的15分（7.5±1.8 vs 15.0±2.3，p <0.001）。最后一次随访的平均HHS为85±14。放射线松动与临床结果无关。结论ARRH在原发性THA中的长期结果与标准水泥杯和现代非水泥杯的结果相当。我们认为，ARRH是用于原发性THA的多功能植入物，特别是在髋臼覆盖受限且髋臼骨储备改变的情况下，ARRH为骨水泥杯提供了足够的结构支撑。Aubigne评分从术前的8分提高到最终随访时的15分（7.5±1.8 vs 15.0±2.3，p <0.001）。最后一次随访的平均HHS为85±14。放射线松动与临床结果无关。结论ARRH在原发性THA中的长期结果与标准水泥杯和现代非水泥杯的结果相当。我们认为，ARRH是用于原发性THA的多功能植入物，特别是在髋臼覆盖受限且髋臼骨储备改变的情况下，ARRH为骨水泥杯提供了足够的结构支撑。Aubigne评分从术前的8分提高到最终随访时的15分（7.5±1.8 vs 15.0±2.3，p <0.001）。最后一次随访的平均HHS为85±14。放射线松动与临床结果无关。结论ARRH在原发性THA中的长期结果与标准水泥杯和现代非水泥杯的结果相当。我们认为，ARRH是用于原发性THA的多功能植入物，特别是在髋臼覆盖受限且髋臼骨储量改变的情况下，ARRH为骨水泥杯提供了足够的结构支撑。结论ARRH在原发性THA中的长期结果与标准水泥杯和现代非水泥杯的结果相当。我们认为，ARRH是用于原发性THA的多功能植入物，特别是在髋臼覆盖受限且髋臼骨储备改变的情况下，ARRH为骨水泥杯提供了足够的结构支撑。结论ARRH在原发性THA中的长期结果与标准水泥杯和现代非水泥杯的结果相当。我们认为，ARRH是用于原发性THA的多功能植入物，特别是在髋臼覆盖受限且髋臼骨储备改变的情况下，ARRH为骨水泥杯提供了足够的结构支撑。