Ishaque B A, Donle E, Gils J, Wienbeck S, Basad E, Stürz H
Klinik für Orthopädie und Orthopädische Chirurgie, Uni-Klinikum Giessen und Marburg, Standort Giessen.
Z Orthop Unfall. 2009 Mar-Apr;147(2):158-65. doi: 10.1055/s-0029-1185527. Epub 2009 Apr 8.
With the help of a clinical and radiological follow-up evaluation 8 years after implantation of the femoral neck prosthesis CUT (ESKA Implants, Lübeck Germany), the question of whether this metaphyseal anchoring implant is recommendable in young patients will be answered.
Between 2000 and 2001 82 CUT-prosthesis procedures were performed in 79 patients (38 female, 41 male patients; average age 51.3 years) and evaluated prospectively. The clinical investigation was carried out according to the criteria of the Harris Hip and Merle d'Aubigné scores. Radiological periprosthetic bone changes were registered and a measurement of the CCD angle and femoral offset was performed. The survival rate was calculated according to both the Kaplan-Meier and the life-table analyses.
During the 12-month follow-up examination the HHS (48.4 preop.) as well as the Merle d'Aubigné score (10 preop.) increased significantly to an average value of 85.1 and 15.8, respectively (p < 0.000). Cumulative survival with replacement of the prosthesis as an end point at 8 years was 49.6 %. Due to 25 aseptic loosenings, three periprosthetic infections and three cases of persisting thigh pains, 31 replacements of the femoral neck prosthesis became necessary up to June 2008. The implantation of the CUT prosthesis led to a significant valgisation (p < 0.001) of 17.4 degrees degrees with a consecutive reduction of the femoral offset of 5 mm. Radiologically periprosthetic progressive radiolucencies, hypertrophic cortical bone changes as well as atrophy of the calcar femoris were often evaluated and interpretated as a sign of a stress shielding and migration process.
The analysis of the eight-year follow-up of 82 CUT prostheses shows that the implant does not fulfil our expectations of a femoral neck prosthesis, in spite of the possibility of a less invasive and bone-saving implantation technique. In view of unacceptable survival rates, valgisation changes of the joint geometry and critical changing procedures, from our point of view the femoral neck prosthesis CUT does not represent a recommendable alternative implant in young, active patients.
通过对股骨颈假体CUT（德国吕贝克ESKA植入物公司）植入8年后的临床和影像学随访评估，回答这种干骺端锚固型植入物在年轻患者中是否值得推荐的问题。
2000年至2001年期间，对79例患者（38例女性，41例男性；平均年龄51.3岁）进行了82例CUT假体手术，并进行前瞻性评估。临床研究按照Harris髋关节评分和Merle d'Aubigné评分标准进行。记录假体周围的放射学骨变化，并测量颈干角（CCD角）和股骨偏心距。根据Kaplan-Meier法和寿命表分析法计算生存率。
在12个月的随访检查中，Harris髋关节评分（术前48.4）和Merle d'Aubigné评分（术前10）均显著提高，分别平均达到85.1和15.8（p<0.000）。以假体置换作为终点，8年时的累积生存率为49.6%。截至2008年6月，由于25例无菌性松动、3例假体周围感染和3例持续的大腿疼痛，有必要对31例股骨颈假体进行置换。CUT假体的植入导致显著的外翻17.4度（p<0.001），同时股骨偏心距连续减少5毫米。放射学上，假体周围逐渐出现的透亮区、肥厚性皮质骨变化以及股骨距萎缩常被评估并解释为应力遮挡和移位过程的迹象。
对82例CUT假体8年随访的分析表明，尽管该植入物有可能采用侵入性较小且节省骨质的植入技术，但它并未达到我们对股骨颈假体的期望。鉴于不可接受的生存率、关节几何形状的外翻变化以及关键的置换手术，从我们的角度来看，CUT股骨颈假体在年轻、活跃的患者中并非一个值得推荐的替代植入物。
