Götze Christian, Rosenbaum Dieter, Hoedemaker Jan, Bottner Friedrich, Steens Wolfram
Department of Orthopaedics, University Hospital of Muenster, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany.
Arch Orthop Trauma Surg. 2009 Feb;129(2):267-74. doi: 10.1007/s00402-008-0717-4. Epub 2008 Oct 31.
Custom-made prosthesis in primary hip arthroplasty based on the concept of a better press-fitting to reach superior clinical results in comparison to conventional implants. Mid-term results provide a more complete picture with respect to gait and electromyographic analyses.
The custom-made femoral component (Adaptiva) was implanted in 24 hips and compared to 23 hips with a conventional implant (Alloclassic-SL). The mean retrospective follow-up times were 3.9 (3-4.9) years and 4.8 (3.1-5.1) years. Clinically, the Harris Hip Score (HHS) and the SF 36 were recorded. Motion analysis data (body kinematics, kinetics and muscle activities) were recorded with 3D gait analysis.
Neither the HHS nor the SF-36 revealed any statistical differences between the two groups (P > 0.05). The radiographic parameters did not show the intended physiologic load transfer. Periprosthetic changes indicated a more distal load transfer of the customized stem. Gait analysis revealed in comparison to the controls (45.03 degrees ), a reduced mean hip range of motion in the sagittal plane by 11.4% (39.9 degrees ) in the customized stem group versus 17.4% (37.2 degrees ) in the conventional stem group. In keeping with the limited range of hip motion kinematic impairments of the ipsilateral knee and ankle joints were detected. The electromyographic amplitudes of the tensor fasciae latae and gluteus medius muscles both for stabilizing the hip joint in the stance phase were significantly higher in both groups.
Compared to a conventional cementless hip prosthesis the custom-made device did not improve the mid-term clinical and radiographic outcome. Despite the individualized reconstruction of the biomechanical hip geometry objective gait analysis failed to show a benefit.
初次髋关节置换术中的定制假体基于更好的压配理念，以期与传统植入物相比获得更优的临床效果。中期结果在步态和肌电图分析方面提供了更完整的情况。
将定制的股骨部件（Adaptiva）植入24例髋关节，并与23例使用传统植入物（Alloclassic-SL）的髋关节进行比较。平均回顾性随访时间分别为3.9（3 - 4.9）年和4.8（3.1 - 5.1）年。临床方面，记录了Harris髋关节评分（HHS）和SF - 36。通过三维步态分析记录运动分析数据（身体运动学、动力学和肌肉活动）。
HHS和SF - 36均未显示两组之间存在任何统计学差异（P > 0.05）。影像学参数未显示出预期的生理负荷转移。假体周围变化表明定制柄的负荷转移更偏向远端。与对照组（45.03度）相比，步态分析显示定制柄组矢状面平均髋关节活动范围减少了11.4%（39.9度），而传统柄组减少了17.4%（37.2度）。与髋关节活动范围受限一致，检测到同侧膝关节和踝关节的运动学损伤。两组中阔筋膜张肌和臀中肌在站立期稳定髋关节的肌电图幅度均显著更高。
与传统非骨水泥髋关节假体相比，定制装置未改善中期临床和影像学结果。尽管对髋关节生物力学几何结构进行了个体化重建，但客观步态分析未显示出益处。
