Thay khớp háng toàn phần với kỹ thuật jumbo cup kèm dời cao tâm xoay trên bệnh nhân mất xương ổ cối nặng có nhóm máu hiếm B Rh(–): Báo cáo ca lâm sàng

Total hip arthroplasty (THA) in patients presenting with significant acetabular bone loss poses considerable surgical challenges, particularly when compounded by rare blood types, which heighten the risk of intraoperative blood loss and complicate transfusion management. Traditional approaches may struggle to provide adequate acetabular coverage and implant stability while minimizing blood requirements. This context underscores the critical need for advanced surgical techniques that can ensure both functional restoration and patient safety. This case report aims to highlight the successful application of the Jumbo cup and high hip center technique as a viable and effective strategy for managing severe acetabular bone loss in a patient with a rare blood type, thereby contributing to improved outcomes in complex THA cases.

Orthopedic surgeons, orthopedic residents, and researchers specializing in total hip arthroplasty, particularly those dealing with complex cases involving acetabular bone loss and patients with rare blood types or hematological challenges.

This paper presents a detailed case report on the successful management of a complex total hip arthroplasty (THA) in a 44-year-old female patient with severe Paprosky IIIA acetabular bone loss and osteonecrosis of the femoral head. The case was further complicated by the patient's rare B Rh(-) blood type and preoperative thrombocytopenia, posing significant challenges for potential blood loss and transfusion. The surgical strategy involved a posterolateral approach utilizing a Jumbo cup and a high hip center technique, which was meticulously planned using TraumaCad software to optimize implant positioning and coverage. The chosen approach aimed to increase acetabular coverage, enhance stability, and critically, minimize blood loss during surgery. Despite the complexity, the procedure was performed efficiently, leading to a complete coverage of the acetabular defect and stable cup fixation without the need for perioperative blood transfusion, a significant advantage given the patient's rare blood type. Postoperatively, the patient showed excellent recovery, being pain-free and ambulating independently at 12-month follow-up, with favorable range of motion and Harris Hip Score improvements. Radiographic assessments confirmed stable implant fixation without signs of loosening or periacetabular bone loss. The findings suggest that the Jumbo cup and high hip center technique offers a safe and effective solution for THA in patients with Paprosky IIIA acetabular bone loss, particularly in scenarios demanding strict blood management, such as those with rare blood types. This approach effectively addresses both mechanical stability and hematological concerns, reducing operative time and minimizing the need for complex bone grafting. While a single case report, it provides valuable insights into managing high-risk THA patients. Future research with larger cohorts and advanced navigation technologies is recommended to further validate long-term outcomes and optimize surgical precision.