Morrey B F, Adams R A, Kessler M
Department of Orthopaedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Br. 2000 Sep;82(7):952-8. doi: 10.1302/0301-620x.82b7.10420.
Between 1985 and 1993, 146 patients (162 hips) had total hip replacement (THR) using a conservative uncemented femoral component. The mean age of the patients was 50.8 years and the mean follow-up was 6.2 years (2 to 13). One patient was lost to follow-up, one died within two years of surgery and one had a revision procedure after a fracture sustained in a road-traffic accident. For the remaining 159, Kaplan-Meier survival analysis was calculated for the incidence of revision because of mechanical loosening or osteolysis. Survival without mechanical loosening at both five and ten years was 98.2%. Survival without osteolysis was 99% at five and 91% at ten years. The Harris hip score improved from a mean of 66.3 before to 90.4 at follow-up. Of particular note is the lack of thigh pain in this group. Radiological analysis showed that 139 stems (88%) had no measurable subsidence, 8 (5%) had less than 2 mm and 12 (7%) had more than 2 mm. Two of the eight and one of the 12 were revised for mechanical loosening. Nine hips were revised for late loosening associated with osteolysis. No reaming of the femoral canal was associated with statistically significant less blood loss compared with a comparable control group of uncemented implants (p < 0.0001). Our study suggests that using a conservative femoral implant does not protect against wear debris but the reliable mechanical stability (98.2%) makes this an attractive design of implant particularly for young patients.
1985年至1993年间，146例患者（162髋）采用保守型非骨水泥股骨假体进行了全髋关节置换术（THR）。患者的平均年龄为50.8岁，平均随访时间为6.2年（2至13年）。1例患者失访，1例在术后两年内死亡，1例在道路交通事故中骨折后进行了翻修手术。对于其余159例患者，计算了因机械性松动或骨溶解而进行翻修的发生率的Kaplan-Meier生存分析。五年和十年时无机械性松动的生存率分别为98.2%。五年时无骨溶解的生存率为99%，十年时为91%。Harris髋关节评分从术前的平均66.3分提高到随访时的90.4分。该组患者尤其值得注意的是没有大腿疼痛。影像学分析显示，139个股骨柄（88%）没有可测量的下沉，8例（5%）下沉小于2mm，12例（7%）下沉大于2mm。8例中的2例和12例中的1例因机械性松动而进行了翻修。9髋因与骨溶解相关的晚期松动而进行了翻修。与非骨水泥植入物的可比对照组相比，未进行股骨髓腔扩髓与统计学上显著更少的失血量相关（p < 0.0001）。我们的研究表明，使用保守型股骨植入物并不能防止磨损碎屑，但可靠的机械稳定性（98.2%）使这种植入物设计对年轻患者特别有吸引力。
