Safir Oleg, Kellett Catherine F, Flint Michael, Backstein David, Gross Allan E
Department of Surgery, Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Clin Orthop Relat Res. 2009 Jan;467(1):206-12. doi: 10.1007/s11999-008-0573-0. Epub 2008 Oct 30.
Substantial bone loss is frequently encountered with revision hip arthroplasty. A proximal femoral allograft may be used to reconstitute bone stock in the multiply revised femur with segmental bone loss of greater than 5 cm. We retrospectively reviewed 92 patients (93 hips) who underwent such proximal femoral allografts. The average age at the surgery was 61 years. The average number of previous revision procedures was 2.5. Six patients were lost to followup. Thirty-four of 36 deceased patients had the original proximal femoral allograft at the time of death. The minimum followup for the 50 remaining patients was 15 years (average, 16.2 years; range, 15-22 years). Analysis included survivorship and radiographic assessment. Of the 50 patients reviewed, two had a failed reconstruction due to infection, six for aseptic loosening, three for nonunion, and four for dislocation. Revision of the proximal femoral allograft for all reasons excluding the acetabulum was performed in seven patients. At last followup, 42 patients (84%) had a well-functioning construct. Proximal femoral allograft for revision hip arthroplasty in femoral segmental bone loss is a durable alternative in most patients for a complex problem.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
翻修髋关节置换术中经常会遇到大量骨质丢失的情况。对于股骨节段性骨丢失超过5cm的多次翻修股骨，可使用近端股骨同种异体骨来重建骨量。我们回顾性分析了92例（93髋）接受此类近端股骨同种异体骨移植的患者。手术时的平均年龄为61岁。既往翻修手术的平均次数为2.5次。6例患者失访。36例死亡患者中有34例在死亡时保留了原近端股骨同种异体骨。其余50例患者的最短随访时间为15年（平均16.2年；范围15 - 22年）。分析包括生存率和影像学评估。在接受评估的50例患者中，2例因感染导致重建失败，6例因无菌性松动，3例因骨不连，4例因脱位。7例患者因除髋臼外的所有原因对近端股骨同种异体骨进行了翻修。在最后一次随访时，42例患者（84%）的植入物功能良好。对于股骨节段性骨丢失的翻修髋关节置换术，近端股骨同种异体骨移植对大多数患者来说是解决复杂问题的一种持久选择。
IV级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
