Goodman Stuart B, Oh Kwang-Jun, Imrie Susanna, Hwang Katherine, Shegog Mychelle
Department of Orthopaedic Surgery, Stanford University School of Medicine. Stanford, California, USA.
Acta Orthop. 2006 Apr;77(2):242-50. doi: 10.1080/17453670610045975.
Revision total hip arthroplasty (THA) in patients with juvenile chronic arthritis (JCA) is complicated by the young age of the patient, poor bone stock and small physical proportions. We report the complications and outcome of a prospective series of 17 revision THAs in Charnley class C JCA patients.
15 acetabular components and 10 femoral components were revised. 13 cementless cups, 2 reconstruction/roof rings and cemented cups, and 4 cemented and 6 cementless femoral stems were implanted. 2 proximal femoral allografts and 1 strut allograft were used. Age at revision was 32 (21-53) years. Follow-up averaged 7 (4-12) years.
2 patients with cemented femoral stems developed loosening, osteolysis and fracture. Both were successfully revised to long-stem cementless implants with strut/proximal femoral allografts. 1 loose, worn cementless cup with osteolysis was revised. 1 patient with a peri-operative infection and late acetabular fracture had a loose, non-revised cementless cup. 1 case of sciatic nerve palsy occurred after revision using a reconstruction ring. 1 late infection necessitated resection arthroplasty. Harris hip scores improved from 53 (34-85) to 76 (47-96).
Revision THA in JCA has a substantial complication rate, even in experienced hands. The problem of obtaining long-term stable fixation, osteolysis, and replenishment of lost bone stock are major difficulties.
幼年慢性关节炎（JCA）患者的全髋关节翻修置换术（THA）因患者年龄小、骨量差和身体比例小而变得复杂。我们报告了一组针对Charnley C级JCA患者的17例翻修THA的前瞻性系列研究的并发症及结果。
对15个髋臼组件和10个股骨组件进行了翻修。植入了13个非骨水泥杯、2个重建/髋臼顶环和骨水泥杯，以及4个骨水泥型和6个非骨水泥型股骨干。使用了2个近端股骨异体骨移植和1个支撑异体骨移植。翻修时的年龄为32（21 - 53）岁。平均随访7（4 - 12）年。
2例使用骨水泥型股骨干的患者出现松动、骨溶解和骨折。两者均成功翻修为带支撑/近端股骨异体骨移植的长柄非骨水泥植入物。1个松动、磨损且伴有骨溶解的非骨水泥杯进行了翻修。1例围手术期感染并伴有晚期髋臼骨折的患者有一个松动的、未翻修的非骨水泥杯。1例在使用重建环翻修后出现坐骨神经麻痹。1例晚期感染需要进行关节切除成形术。Harris髋关节评分从53（34 - 85）提高到76（47 - 96）。
即使是经验丰富的医生，JCA患者的THA翻修术也有相当高的并发症发生率。获得长期稳定固定、骨溶解以及补充丢失的骨量是主要难题。
