Total Hip Arthroplasty in Patients With Post-Traumatic Bone Defects and Acetabular Deformities

Abstract

Backround. Total hip replacement in cases of traumatic changes of the acetabulum refers to cases of difficult primary arthroplasty and requires detailed preoperative planning and accurate restoration of anatomical relationships in the operated joint.
 The aim of the study was to evaluate the structure of pathological changes in the acetabulum in patients with posttraumatic hip arthrosis, to develop a method for their detailed description and to determine the tactics of choosing the type of acetabulum implant.
 Methods. The results of treatment of 194 patients with the consequences of acetabulum fractures who underwent total hip arthroplasty in the period from 2014 to 2022 were analyzed. The study was conducted in two stages, at the first stage, the structure of pathological changes, such as defect, deformation, changes in the center of rotation and offset (relatively healthy contralateral joint), was analyzed. A method was developed for choosing the tactics of implantation of the acetabulum component, based on a detailed description of the defect and deformation of the acetabulum. The second stage analyzed the results of treatment of patients for whom planning and surgical treatment was carried out in the period from 2020 to 2022 using the proposed method.
 Results. During the first stage of the study, it was revealed that the magnitude of the change in the indicators of the displacement of the rotation center and offset changes by more than 8 mm. statistically significantly increases the likelihood of complications by 17.9%. The restoration of the rotation and offset center reduces the number of complications by 22.3%. The proposed method makes it possible to statistically reliably restore anatomical relationships in the operated hip joint and reduce the number of complications by 10%.
 Conclusion. The proposed method allows us to qualitatively and quantitatively describe pathological changes in the bone tissue of the acetabulum. Depending on the degree of displacement of the center of rotation, the walls of the acetabulum and the nature of the defect of the supporting bone tissue, the surgeon can determine the tactics of surgical treatment.

Biological fixation of customized implants for post-traumatic acetabular deformities and defects

“…A test group was formed that included 30 patients with significant post-traumatic acetabulum defects of grade III and IV according to AAOS classification. All patients underwent preoperative planning according to the developed algorithm [17]; customized implants with the pore size determined in the experiment (400-499 μm) were created, and surgical treatment of the defects was carried out. In addition to clinical and functional results, analyzed parameters included the state of bone tissue surrounding the customized implant, restoration of anatomical relationships in the hip joint, such as threedimensional spatial displacement of the rotation center and change in femoral offset in relation to the healthy contralateral joint parameters.…”