Utilidad del aloinjerto óseo estructurado para defectos acetabulares en prótesis de revisión / Utility of a structured bone allograft for acetabular defects in the setting of a revision prosthesis

RESUMEN

Introducción: La coxartrosis se considera una patología creciente; existiendo una demanda importante en la artroplastía total de cadera primaria en las próximas décadas, por lo tanto, incrementará la artroplastía de revisión de cadera; las indicaciones más comunes para la revisión son el aflojamiento de los componentes, inestabilidad de la cadera e infección, involucrando el componente acetabular en más de 50% de las revisiones. La pérdida ósea acetabular es de los mayores retos en la artroplastía de revisión de cadera. Objetivos: Determinar en estudios de imagen la osteointegración del aloinjerto mediante escalas radiográficas de AAOS, grado de funcionalidad de la cadera afectada mediante Harris Hip Score (HHS), valorar la satisfacción personal del paciente e identificar y describir las complicaciones. Material y métodos: Es un estudio observacional, longitudinal, retrospectivo, descriptivo, básico y clínico. Se seleccionaron expedientes de pacientes sometidos a cirugía de revisión protésica de cadera con aflojamiento protésico y defecto acetabular en quienes se haya utilizado aloinjerto óseo estructurado en el período de Enero 2007 a Abril 2012. Se realizó un seguimiento con controles a seis meses y un año. Resultados: Fueron 18 pacientes, 61% mujeres y 39% hombres, edad entre 47-79 años, con defecto acetabular grado IIB 44.4%, IIC 44.4% y III 11.2%, según clasificado por Paprosky, HHS de 27 puntos a 72.3 puntos a un año. Osteointegración al 100% en 9 pacientes, 75% en 6 y 50% en 3 pacientes. Un paciente con infección periprotésica aguda.

ABSTRACT

Introduction: Coxarthrosis is considered as an increasingly frequent condition that will lead to an important demand for primary total hip arthroplasty in the coming decades and this, in turn, will increase the number of revision hip arthroplasties. The most common indications for revision are component loosening, hip instability and infection, with involvement of the acetabular component in more than 50% of revision procedures. Acetabular bone loss is one of the major challenges of revision hip arthroplasty. Objectives: To determine, by means of imaging studies, allograft osseointegration using the AAOS radiographic scales, the performance grade of the affected hip using the Harris Hip Score (HHS), and patient personal satisfaction, as well as identify and describe complications. Material and methods: Observational, longitudinal, retrospective, descriptive, basic, clinical trial. The records of patients subjected to revision hip arthroplasty who experienced prosthetic loosening and had an acetabular defect treated with structured bone allograft between January 2007 and April 2012 were selected. Patients were followed-up at 6 and 12 months and compared with controls. Results: The total number of patients was 18, 61% females and 39% males. Age range was 47-79 years. The acetabular defect grade was as follows 44.4% were IIB; 44.4% were IIC, and 11.2% were III, according to the Paprosky classification. The HHS went from 27 to 72.3 at one year. Osseointegration was 100% in 9 patients, 75% in 6, and 50% in 3 patients. One patient had acute periprosthetic infection. Conclusions: This method represents a good treatment option for acetabular defects, as it provides significant improvement according to the HHS and proper allograft osseointegration, which helps patients increase their bone stock for future revision procedures.