Background:

DDH with coxarthrosis causes significant deformity and bone deficiency. Various reconstructive techniques have been proposed to treat developmental dysplasia of the hip. However, the existing literature has not yet reached a consensus on the best technique regarding long-term survival.

Objectives:

This study aims to evaluate the long-term survival of uncemented hydroxyapatite (HA) coated acetabular components augmented with a femoral head autograft.

Methods:

We retrospectively reviewed the cases of 31 hips in 29 patients (24 female, 5 male, mean age 45.06 years) treated with HA-coated cementless components and femoral head autograft between 2000-2008 with a minimum follow-up of 10 years. Graft resorption, cup loosening and the anatomical hip centre were determined. Functional outcomes were calculated using the Harris Hip Scoring system. The survival of the acetabular component was evaluated using the Kaplan-Meier method.

Results:

In 24 hips (77,4%), we reconstructed the hip centre anatomically. The remaining cups had variable deviations from the anatomical rotation centre. Only one patient required revision due to loosening. Survival analysis revealed 96.8% survival at 10 years. The mean Harris Hip Score was 39.23 preoperatively and 84.77 at final follow-up. There was no statistical correlation between revision and any of the measured parameters.

Discussion:

Acetabular reconstruction with a femoral head autograft allows for anatomical cup positioning, early structural support and increases bone stock for future revisions. Although our prior cemented cup study showed that anatomical cup orientation is critical, this study demonstrated the absence of a correlation between implant failure and cup positioning, suggesting that HA-coated cementless cups are more stable and forgiving.

Conclusions:

HA-coated acetabular cups augmented with femoral head autograft provided long-term, reliable and durable cup fixation in dysplastic hips of young adults.

中文翻译：

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采用自体股骨头移植进行解剖髋臼重建，治疗发育性髋关节发育不良 (DDH)，至少随访 10 年

背景：

伴有髋关节病的 DDH 会导致严重的畸形和骨质缺乏。已经提出了各种重建技术来治疗髋关节发育不良。然而，现有文献尚未就长期生存的最佳技术达成共识。

目标：

本研究旨在评估自体股骨头移植物增强的非骨水泥羟基磷灰石 (HA) 涂层髋臼组件的长期存活率。

方法：

我们回顾性分析了 29 名患者（24 名女性，5 名男性，平均年龄 45.06 岁）2000 年至 2008 年间接受 HA 涂层非骨水泥假体和自体股骨头移植治疗的 31 个髋关节病例，随访时间至少为 10 年。确定移植物吸收、杯松动和解剖髋关节中心。使用哈里斯髋关节评分系统计算功能结果。使用 Kaplan-Meier 方法评估髋臼假体的存活率。

结果：

在 24 个髋关节（77.4%）中，我们在解剖学上重建了髋关节中心。其余的杯子与解剖旋转中心有不同的偏差。只有一名患者因松动而需要翻修。生存分析显示 10 年生存率为 96.8%。术前平均 Harris 髋关节评分为 39.23，最终随访时为 84.77。修正与任何测量参数之间不存在统计相关性。

讨论：

使用自体股骨头移植进行髋臼重建可以实现解剖杯定位、早期结构支撑并增加骨量以供未来修复。尽管我们之前的骨水泥杯研究表明解剖杯定位至关重要，但这项研究证明种植体失败和杯定位之间不存在相关性，这表明HA涂层的非骨水泥杯更加稳定和宽容。

结论：

HA 涂层髋臼杯加自体股骨头移植物为年轻人发育不良的髋关节提供了长期、可靠和耐用的髋臼杯固定。