Revision surgery for complex acetabular defects is still technically challenging. In this study, we discussed and compared the clinical and radiological outcomes of revision surgery between two methods using double-trabecular metal (TM) cups alone or combined with impacting bone grafting (IBG). The records of 18 patients (18 hips) who underwent revision surgery using double-trabecular metal (double-TM) cups between 2008 and 2016 were retrospectively reviewed. All the patients were diagnosed with Paprosky III acetabular defects. The acetabular defects were reconstructed by double-TM cups alone or in combination with IBG. We used the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA), and Short Form 36 (SF-36) to evaluate the clinical outcomes. Pelvis plain X-ray was used to assess hip center of rotation (COR), abduction angle and anteversion angle of acetabular cup, and incorporation of the bone graft to host bone. The median follow-up time was 61.0 (IQR 56.0 to 65.8) months. No patients underwent re-revision for loosening or any other reasons. Complications included 3 patients (16.7%) with early dislocation and 3 patients (16.7%) with delayed wound healing. The average mHHS and UCLA preoperatively were 44.1 ± 4.0 (range 35 to 50) and 2.6 ± 0.7 (range 2 to 4), respectively and at the last follow-up were 73.7 ± 4.2 (range 68 to 85) and 7.3 ± 0.5 (range 7 to 8), respectively. The mean SF-36 scores at the last follow-up were improved significantly than preoperative scores, especially in bodily pain category (P < 0.05). The average limb-length discrepancy (LLD) decreased significantly from 24.2 ± 2.6 (range 20 to 32) mm preoperatively to 5.8 ± 1.8 (range 3 to 9) mm at the last follow-up, respectively. However, there was no significant difference between two methods at the last follow-up in terms of mHHS, UCLA, SF-36, LLD, and hip COR (P > 0.05). Radiographic evaluation demonstrated bone graft incorporation in all hips in the follow-up. Defect reconstruction using double-TM cups alone or combined with IBG are practical and reliable treatment options for Paprosky III acetabular defects without pelvic discontinuity. Nevertheless, high postoperative complication rate, especially in terms of dislocation, remains a challenge.

中文翻译：

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单独使用双小梁金属杯或结合冲击式植骨治疗复杂的髋臼缺损的翻修手术的中期结果。

复杂髋臼缺损的翻修手术在技术上仍然具有挑战性。在这项研究中，我们讨论并比较了两种单独使用双小梁金属（TM）杯或结合冲击植骨（IBG）的方法在翻修手术中的临床和放射学结果。回顾性分析了2008年至2016年间使用双小梁金属（double-TM）杯进行翻修手术的18例患者（18髋）的记录。所有患者均被诊断出患有Paprosky III髋臼缺损。单独或与IBG组合使用double-TM杯重建髋臼缺损。我们使用改良的哈里斯臀部评分（mHHS），加利福尼亚大学洛杉矶分校（UCLA）和简短表格36（SF-36）来评估临床结果。骨盆X线平片用于评估髋关节旋转中心（COR），髋臼杯的外展角和前倾角，以及将骨移植物植入宿主骨中。中位随访时间为61.0（IQR 56.0至65.8）个月。没有患者因松动或任何其他原因而接受重新修订。并发症包括3例（16.7％）的早期脱位患者和3例（16.7％）的伤口愈合延迟。术前平均mHHS和UCLA分别为44.1±4.0（范围35至50）和2.6±0.7（范围2至4），最后一次随访时分别为73.7±4.2（范围68至85）和7.3±0.5（范围分别为7到8）。在最后一次随访中，SF-36的平均得分比术前得分明显提高，尤其是在身体疼痛类别中（P <0.05）。平均肢长差异（LLD）从术前的24.2±2.6（20至32）mm显着降低至5.8±1。在最后一次随访中分别为8（3至9）mm。但是，在最后一次随访中，两种方法在mHHS，UCLA，SF-36，LLD和髋COR方面无显着差异（P> 0.05）。影像学评估显示，随访中所有髋关节均植入了骨移植物。单独使用double-TM杯或结合IBG进行缺损修复是Paprosky III髋臼缺损且没有骨盆不连续的实用且可靠的治疗选择。然而，术后并发症率高，尤其是脱位，仍然是一个挑战。影像学评估显示，随访中所有髋关节均植入了骨移植物。单独使用double-TM杯或结合IBG进行缺损修复是Paprosky III髋臼缺损且没有骨盆不连续的实用且可靠的治疗选择。然而，术后并发症率高，尤其是脱位，仍然是一个挑战。影像学评估显示，随访中所有髋关节均植入了骨移植物。单独使用double-TM杯或结合IBG进行缺损修复是Paprosky III髋臼缺损且没有骨盆不连续的实用且可靠的治疗选择。然而，术后并发症率高，尤其是脱位，仍然是一个挑战。