Malhotra R, Dua Aman, Kiran E Krishna, Bhan S
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
Arch Orthop Trauma Surg. 2008 Apr;128(4):355-62. doi: 10.1007/s00402-007-0334-7. Epub 2007 Apr 25.
Cementless femoral revision has become increasingly popular because the cementless implants provide the potential for long-term biologic implant fixation. The IOTA interlocking femoral stem is a hydroxyapatite-coated stem with the option of interlocking the stem distally. The aim of the current study was to evaluate the short-term results of IOTA interlocking stem.
We retrospectively reviewed the results of 18 total hip arthroplasties in 17 patients performed between July 2002 and 2004 using the IOTA interlocking stem. In-patient records were retrieved and in addition to demographic data the indication for revision, the preoperative and postoperative Harris Hip scores, need for allografts were noted. The bone deficiency was classified based on the AAOS classification. Intraoperative complications and problems if any were retrieved from the authors' operative notes. Radiographs at the final follow up were evaluated by the criteria described by Engh et al. (Clin Orthop 257:107-128, 1990)
Average age at the time of revision was 57 years. Preoperatively five femora showed type I deficiency, type II deficiency was seen in three, type III in nine and type IV deficiency in one femur. In five hips the calcar replacing prosthesis was implanted to manage the proximal calcar defect, in one hip allograft was used to reconstruct the calcar. One patient sustained intraoperative fracture of the shaft of the femur while implanting the trial prosthesis and one patient had a perforation of the posterior cortex of femur while trying to remove the cement. The mean follow up period was 33.5 months (range 27-45 months). The mean preoperative Harris Hip score was 36 (range 23-50), which improved to 77 (range 68-92) at the time of final follow up. None of the stems required revision and at minimum 27 months follow up, bony ingrowth was noted in 83.33% of the stems.
IOTA interlocking stem has shown promising short-term results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony in growth owing to hydroxyapatite coating. Intraoperative fracture is a potential drawback because of the straight nature of the stem. The calcar replacing option of the stem is especially useful in patients with deficient calcar as a substitute for the allograft.
非骨水泥型股骨翻修术越来越受欢迎，因为非骨水泥型植入物具有实现长期生物学固定的潜力。IOTA互锁股骨髓内钉是一种羟基磷灰石涂层髓内钉，可选择在远端互锁髓内钉。本研究的目的是评估IOTA互锁髓内钉的短期效果。
我们回顾性分析了2002年7月至2004年期间17例患者行18例全髋关节置换术使用IOTA互锁髓内钉的结果。检索住院病历，除人口统计学数据外，记录翻修指征、术前和术后Harris髋关节评分、是否需要同种异体骨移植。根据美国骨与软组织外科医师协会（AAOS）分类对骨缺损进行分类。从作者的手术记录中检索术中并发症及相关问题。末次随访时的X线片根据Engh等人（《临床骨科杂志》257:107 - 128, 1990）描述的标准进行评估。
翻修时的平均年龄为57岁。术前，5个股骨显示I型缺损，3个股骨显示II型缺损，9个股骨显示III型缺损，1个股骨显示IV型缺损。5例髋关节植入了替代小粗隆的假体以处理近端小粗隆缺损，1例髋关节使用同种异体骨重建小粗隆。1例患者在植入试验假体时发生股骨干术中骨折，1例患者在试图取出骨水泥时股骨后皮质穿孔。平均随访时间为33.5个月（范围27 - 45个月）。术前Harris髋关节评分平均为36分（范围23 - 50分），末次随访时提高到77分（范围68 - 92分）。所有髓内钉均无需翻修，在至少27个月的随访中，83.33%的髓内钉出现骨长入。
IOTA互锁髓内钉在股骨翻修术中显示出良好的短期效果。其优点是初始轴向和旋转稳定性以及由于羟基磷灰石涂层导致的一致的骨长入。由于髓内钉的直形结构，术中骨折是一个潜在的缺点。髓内钉的替代小粗隆选项对于小粗隆缺损的患者作为同种异体骨的替代品特别有用。
