Effenberger H, Imhof M, Witzel U, Rehart S
Grieskirchen, Osterreich.
Orthopade. 2005 May;34(5):477-500; quiz 501. doi: 10.1007/s00132-005-0800-2.
Optimal fixation of cementless stems is a precondition for long-lasting stability. Thus, anchorage, stabilizers, material and surface are of essential importance. To achieve primary stability, good rotational, tilting and axial stability is necessary. Stabilizers such as fins and ribs optimize stability. The CCD-angle and length of neck-axis determine the offset (laterality), leg-length and center of rotation. The stem, is responsible for the fixation of the prosthesis and for transmitting forces to the bone. The types of fixation are epiphyseal (the femoral head is covered by a cup prosthesis), metaphyseal and meta-diaphyseal (with straight or anatomically shaped monoblock-prostheses of different lengths, modular and custom-made prostheses) and diaphyseal (using predominantly modular systems). Titanium alloys are the predominate material for cementless stems. The surfaces are generally corundum-blasted or plasma sprayed. For metaphyseal and meta-diaphyseal stems, survival rates from 95 to 98% have been reached after 15 years. Diaphyseal-fixed stems have mid-term survival-rates of 92-99%.
非骨水泥型股骨柄的最佳固定是长期稳定性的前提条件。因此，锚固、稳定装置、材料和表面至关重要。为实现初始稳定性，良好的旋转、倾斜和轴向稳定性是必要的。诸如鳍片和肋条等稳定装置可优化稳定性。颈干角和颈轴长度决定了偏心距（侧方性）、腿长和旋转中心。股骨柄负责假体的固定并将力传递至骨骼。固定类型包括骨骺型（股骨头由髋臼假体覆盖）、干骺端型和干骺-骨干型（使用不同长度的直型或解剖形状的整体式假体、模块化和定制假体）以及骨干型（主要使用模块化系统）。钛合金是非骨水泥型股骨柄的主要材料。表面通常进行喷砂或等离子喷涂处理。对于干骺端型和干骺-骨干型股骨柄，15年后的生存率达到了95%至98%。骨干固定型股骨柄的中期生存率为92%至99%。
