Hungerford Marc W, Hungerford David S, Khanuja Harpal S, Pietryak B Patricia, Jones Lynne C
J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:126-30. doi: 10.2106/JBJS.F.00777.
Recent studies have indicated that the rate of successful long-term outcome after primary total hip arthroplasty for patients with osteonecrosis may be improved with the use of later-generation porous-coated prostheses (biologic ingrowth fixation) and cement techniques (cement fixation). Less is known about the long-term outcome after revision arthroplasty in the same patient population. The purpose of this study was to characterize the clinical and radiographic outcomes of revision total hip arthroplasty in patients with osteonecrosis.
We evaluated thirty-four osteonecrotic hips in thirty patients who had undergone revision of a femoral component of a prior total hip arthroplasty. There were nineteen men (twenty-two hips) and eleven women (twelve hips) with a mean age of forty-six years. Thirty one of thirty-four hips were implanted without cement. The cementless prostheses were of different stem lengths, but thirty of thirty-one were proximally porous coated. The mean duration of follow-up was 8.2 years. Prerevision radiographs were used to determine the degree of femoral bone loss according to the classification system of Della Valle and Paprosky. The need for revision was analyzed for correlation to known risk factors for osteonecrosis, age and gender of the patient, and degree of prerevision femoral deficiency. A clinical and radiographic evaluation of outcome was performed.
This was the first revision for twenty-seven hips, the second for five hips, and the third for two hips. Preoperatively, the defects included four Type I, nine Type II, fifteen Type IIIA, two Type IIIB, one Type IV, and three unknown. The femoral component was rerevised in twelve of the thirty-four hips. One of the failures was the only fully porous-coated stem that was implanted. One of the three cemented implants failed, as compared with eleven of the thirty-one noncemented implants. Survival rates were 90.9% at five years, 54.8% at ten years, 54.8% at fifteen years, and 27.4% at twenty years. With the small sample size, no relationship could be identified with regard to frequency of re-revision and defects, associated risk factors, patient age, or gender.
There was a high failure rate of revised, uncemented, proximally coated femoral components in patients with osteonecrosis of the femoral head at the time of the intermediate-term follow-up. The cause of failure could not be correlated with patient age, gender, risk factors for osteonecrosis, or femoral bone stock.
Therapeutic Level IV. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
近期研究表明，对于骨坏死患者，采用新一代多孔涂层假体（生物固定）和骨水泥技术（骨水泥固定）进行初次全髋关节置换术后，长期成功的概率可能会提高。对于同一患者群体翻修关节置换术后的长期疗效，人们了解得较少。本研究的目的是描述骨坏死患者翻修全髋关节置换术的临床和影像学结果。
我们评估了30例患者的34个股骨头坏死髋关节，这些患者之前已经接受过全髋关节置换术的股骨部件翻修。其中男性19例（22髋），女性11例（12髋），平均年龄46岁。34髋中的31髋未使用骨水泥植入假体。非骨水泥假体的柄长度各不相同，但31例中有30例近端为多孔涂层。平均随访时间为8.2年。术前X线片根据Della Valle和Paprosky分类系统确定股骨骨量丢失程度。分析翻修的必要性与已知的骨坏死危险因素、患者年龄和性别以及术前股骨缺损程度之间的相关性。对结果进行临床和影像学评估。
这是27髋的首次翻修，5髋的第二次翻修，2髋的第三次翻修。术前，缺损包括4例I型、9例II型、15例IIIA型、2例IIIB型、1例IV型和3例不明类型。34髋中有12髋的股骨部件再次进行了翻修。失败的病例中有1例是唯一植入的完全多孔涂层柄。3例骨水泥植入物中有1例失败，而31例非骨水泥植入物中有11例失败。5年生存率为90.9%，10年为54.8%，15年为54.8%，20年为27.4%。由于样本量小，在再次翻修频率与缺损、相关危险因素、患者年龄或性别方面未发现相关性。
在中期随访时，股骨头坏死患者翻修的近端涂层非骨水泥股骨部件失败率较高。失败原因与患者年龄、性别、骨坏死危险因素或股骨骨量无关。
治疗性IV级。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
