Harris W H
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114.
Clin Orthop Relat Res. 1992 Jan(274):6-11.
During the first 32 years of total hip arthroplasty, high risk of sepsis, improved prevention of infection, problems of loosening, new disease of bone lysis secondary to particulate debris, and the complexities of cementless fixation have taught orthopedic surgeons many lessons. These lessons include the following: (1) In cemented THA, bone cement can be made five-times stronger just by porosity reduction; the critical interface in a cemented femoral stem is the cement-metal interface, not the cement-bone interface; and no one has solved the long-term fixation problem in cemented sockets. (2) In cementless implants, the disuse osteoporosis that occurs around cementless femoral components can be severe; the use of cementless implants does not eliminate bone lysis; only small amounts of bone ingrowth occur in many cementless implants, particularly in revision cases; and little or no bone ingrowth occurs from grafts. Today, however, some of these lessons are ignored by surgeons. If progress is to be made in arthroplasty, these lessons from the past should be learned and warning signs of the present should be heeded.
在全髋关节置换术开展的头32年里，败血症的高风险、感染预防的改善、松动问题、由颗粒碎屑继发的骨溶解新疾病以及非骨水泥固定的复杂性给骨科医生上了很多课。这些经验教训包括：（1）在骨水泥型全髋关节置换术中，仅通过减少孔隙率就能使骨水泥强度提高五倍；骨水泥型股骨柄的关键界面是骨水泥-金属界面，而非骨水泥-骨界面；并且没有人解决骨水泥型髋臼杯的长期固定问题。（2）在非骨水泥型植入物中，非骨水泥型股骨部件周围发生的废用性骨质疏松可能很严重；使用非骨水泥型植入物并不能消除骨溶解；许多非骨水泥型植入物，尤其是翻修病例中，只有少量骨长入；并且移植物几乎没有或没有骨长入。然而如今，其中一些经验教训被外科医生忽视了。如果要在关节置换术中取得进展，就应该吸取过去的这些经验教训，并留意当前的警示信号。
