Cadera / Hip: cada milímetro cuenta

Restoration of the Hip Center During THA Performed for Protrusio Acetabuli Is Associated With Better Implant Survival
Yaser M. K. Baghdadi MD, A. Noelle Larson MD, Rafael J. Sierra MD
Clin Orthop Relat Res (2013) 471:3251–3259
DOI 10.1007/s11999-013-3072-x

Abstract

Background
Acetabular protrusio is an uncommon finding in hip arthritis. Several reconstructive approaches have been used; however the best approach remains undefined. Questions/purposes Our purposes in this study were to (1) describe the THA survivorship for protrusio as a function of the acetabular component, (2) evaluate survi- vorship of the cup as a function of restoration of radiographic hip mechanics and offset, and (3) report the long-term clinical results.

Methods
One hundred twenty-seven patients (162 hips) undergoing primary THA with acetabular protrusio were retrospectively reviewed. The mean age of the patients at surgery was 66 ± 13 years, and the mean followup was 10 ± 6 years (range, 2–25 years).The cup fixation was uncemented in 107 (83 with bone graft) and cemented in 55 hips (14 with bone graft). Preoperative and postoperative radiographs were reviewed for restoration of hip mechanics and offset.

Results
The THA survival from aseptic cup revision at 15 years was 89% (95% CI, 75%–96%) for uncemented compared with 85% (95% CI, 68%–94%) for cemented cups. The risk of aseptic cup revision significantly increased by 24% (hazards ratio, 1.24; 95% CI, 1.02–1.5) for every 1 mm medial or lateral distance away from the native hip center of rotation to the prosthetic head center. Harris hip scores were improved by mean of 27 ± 20 points (n = 123) with a higher postoperative score for uncemented bone grafted compared with solely cemented cups (81 ± 16 versus 71 ± 20 points).

Conclusions
Restoring hip center of rotation using an uncemented cup with or without bone graft was associated with increased durability in our series. There was a 24% increase in the risk of aseptic cup revision for every 1 mm medial or lateral distance away from the native hip center to the prosthetic head center.

Level of Evidence
Level III, therapeutic study