Kinner B, Willmann G, Storz S, Kinner J
Klinik für Unfallchirurgie und Orthopädie, Städtische Kliniken Esslingen.
Z Orthop Ihre Grenzgeb. 1999 Mar-Apr;137(2):114-21. doi: 10.1055/s-2008-1039344.
Cementless hip arthroplasty is not completely satisfactory--even with macroporous structured surface. Medium term results are sometimes disappointing because of insufficient secondary stability. Thus our aim was to improve fixation by additional coating with hydroxyapatite.
200 consecutive patients who had hydroxyapatite-coated cementless hip replacement with a macroporous hip prosthesis (09/92-03/96) were studied prospectively. All patients were included in a prospective follow up schedule according to the criteria of Johnston et al. As measure of clinical outcome we calculated Harris Hip Score as well as Enghs Score to assess radiologic fixation and stability.
91% could be followed up regularly. No revision because of aseptic loosening had to be done. Analysis of clinical results showed almost painless patients from early after the operation--especially no thigh pain. Average HHS after 2 years was 97. Radiological evaluation showed early and complete osteointegration of all components. According to Engh-Score they are stable and well fixed.
HA coated macroporous implants provide some striking advantages, which encouraged us to continue with this system. By early and secure bony ingrowth a fibrous interface is avoided and thereby also long-lasting thigh pain.
非骨水泥型髋关节置换术并不完全令人满意——即使是具有大孔结构表面的假体。由于二次稳定性不足,中期结果有时令人失望。因此,我们的目标是通过额外涂覆羟基磷灰石来改善固定效果。
对连续200例接受羟基磷灰石涂层非骨水泥型髋关节置换术并使用大孔髋关节假体的患者(1992年9月至1996年3月)进行前瞻性研究。根据约翰斯顿等人的标准,所有患者都被纳入前瞻性随访计划。作为临床结果的衡量指标,我们计算了Harris髋关节评分以及Enghs评分,以评估放射学上的固定和稳定性。
91%的患者能够得到定期随访。没有因无菌性松动而进行翻修手术的情况。临床结果分析显示,术后早期患者几乎无痛——尤其是没有大腿疼痛。2年后的平均Harris髋关节评分为97分。放射学评估显示所有组件均早期且完全骨整合。根据Engh评分,它们稳定且固定良好。
羟基磷灰石涂层的大孔植入物具有一些显著优势,这促使我们继续使用该系统。通过早期且可靠的骨长入,避免了纤维界面的形成,从而也避免了长期的大腿疼痛。