Objective To analyze the short-term effectiveness and safety of personalized three-dimensional (3D) printed customized prostheses in severe Paprosky type Ⅲ acetabular bone defects. Methods A retrospective analysis was conducted on 8 patients with severe Paprosky type Ⅲ acetabular bone defects and met the selection criteria between January 2023 and June 2024. There were 3 males and 5 females, with an average age of 64.6 years ranged from 56 to 73 years. All primary replacement prostheses were non-cemented, including 1 ceramic-ceramic interface, 1 ceramic-polyethylene interface, and 6 metal-polyethylene interfaces. The time from the primary replacement to the revision was 4 days to 18 years. The reasons for revision were aseptic loosening in 5 cases, revision after exclusion in 2 cases, and repeated dislocation in 1 case. The preoperative Harris score was 39.5±3.7 and the visual analogue scale (VAS) score was 7.1±0.8. The operation time, intraoperative blood loss, hospital stay, and complications were recorded. The hip function was evaluated by Harris score, and the degree of pain was evaluated by VAS score. The acetabular cup abduction angle, anteversion angle, rotational center height, greater trochanter height, and femoral offset were measured on X-ray film. Results The operation time was 95-223 minutes, with an average of 151.13 minutes. The intraoperative blood loss was 600-3 500 mL, with an average of 1 250.00 mL. The hospital stay was 13-20 days, with an average of 16.88 days. All 8 patients were followed up 2-12 months, with an average of 6.4 months. One patient had poor wound healing after operation, which healed well after active symptomatic treatment. One patient had lower limb intermuscular vein thrombosis, but no thrombosis was found at last follow-up. No serious complications such as aseptic loosening, infection, dislocation, and periprosthetic fracture occurred during the follow-up. At last follow-up, the Harris score was 72.0±6.2 and the VAS score was 1.8±0.7, which were significantly different from those before operation (t=?12.011, P<0.001; t=16.595, P<0.001). On the second day after operation, the acetabular cup abduction angle ranged from 40° to 49°, with an average of 44.18°, and the acetabular cup anteversion angle ranged from 19° to 26°, with an average of 21.36°, which were within the “Lewinneck safety zone”. There was no significant difference in the rotational center height, greater trochanter height, and femoral offset between the healthy side and the affected side (P>0.05). ConclusionThe use of personalized 3D printed customized prostheses for the reconstruction of severe Paprosky type Ⅲ acetabular bone defects can alleviate pain and enhances hip joint function, and have good postoperative prosthesis position, without serious complications and have good safety.
Objective To investigate the short- and mid-term effectiveness and prosthesis survival rate in patients undergoing total knee arthroplasty (TKA) using domestic cementless knee prostheses with three-dimensional (3D)-printed trabecular metal interface. Methods A retrospective analysis was performed on the clinical data of 79 patients who underwent primary TKA for end-stage knee disorders, met the selection criteria and were treated between December 2021 and March 2022. There were 39 patients in the cementless group receiving cementless knee prostheses with 3D-printed trabecular metal interface, and 40 patients in the cemented group adopting posterior-stabilized cement-fixed knee prostheses. Baseline data including age, gender, body weight, disease type, disease duration, and preoperative Knee Society Score (KSS) (clinical score and function score) showed no significant differences between the two groups (P>0.05). Operation time, intraoperative blood loss, and complications were recorded and compared between groups. KSS clinical and function scores before operation and at last follow-up were used to evaluate knee functional recovery. Radiographic assessment was conducted to detect prosthesis loosening, osteolysis, prosthesis subsidence, joint dislocation, and other abnormalities. Prosthesis survival rate was calculated with complete or partial prosthesis removal defined as the endpoint event, and Kaplan-Meier method was adopted to plot prosthesis survival curves. Results All patients successfully completed surgery. No significant intergroup differences were found in operation time and intraoperative blood loss (P>0.05). All patients in the cementless group and cemented group were followed up for (28.4±2.4) months and (28.2±2.8) months respectively, without significant difference (t=?0.274, P=0.785). At last follow-up, both KSS clinical and function scores were significantly higher than preoperative values in both groups (P<0.05), while no significant intergroup differences were observed in the changes of each score (P>0.05). X-ray films at last follow-up revealed no prosthesis loosening, osteolysis, prosthesis subsidence, or joint dislocation in any patient. During follow-up, 5 cases of intermuscular venous thrombosis occurred in the cementless group; in the cemented group, there were 6 cases of intermuscular venous thrombosis, 1 case of poor wound healing, 1 case of periprosthetic joint infection, 1 case of periprosthetic fracture, and 1 case of all-cause death. The complication rates of the two groups (12.8% vs 25.0%) were not different (P>0.05). One revision surgery was performed for periprosthetic joint infection and 1 for periprosthetic fracture in the cemented group, corresponding to a prosthesis survival rate of 95.0%; no endpoint events occurred in the cementless group, with a prosthesis survival rate of 100.0%. Kaplan-Meier survival curve analysis demonstrated no significant difference in prosthesis survival rates between the two groups (Log-rank test: χ2=2.028, P=0.154). Conclusion TKA performed with domestic cementless knee prostheses featuring 3D-printed trabecular metal interface shows no obvious disadvantages compared with cemented prostheses in terms of postoperative function, complication rate, and prosthesis survival rate, which represents a safe and viable prosthesis option.