55岁以下患者使用非骨水泥喷砂直锥形钛柄。15至20年的结果。

Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results.

作者信息

Aldinger Peter R, Jung Alexander W, Pritsch Maria, Breusch Steffen, Thomsen Marc, Ewerbeck Volker, Parsch Dominik

机构信息

Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.

出版信息

J Bone Joint Surg Am. 2009 Jun;91(6):1432-9. doi: 10.2106/JBJS.H.00297.

DOI:10.2106/JBJS.H.00297

PMID:19487522

Abstract

BACKGROUND

Total hip arthroplasty without cement is frequently performed in young active patients, but only limited outcomes data are available after durations of follow-up of more than fifteen years.

METHODS

We retrospectively evaluated the clinical and radiographic results of a consecutive series of 154 total hip arthroplasties (in 141 patients) performed with an uncemented grit-blasted straight tapered titanium femoral stem combined with a threaded socket in patients under the age of fifty-five years. The median duration of follow-up was seventeen years. Clinical results were evaluated with use of the Harris hip score. The canal fill index was used as the criterion to determine the adequacy of stem sizing. Kaplan-Meier survivorship analysis was performed to predict long-term outcomes.

RESULTS

The stem was undersized, with a canal fill index of < or =80%, in forty-one hips (27%). Late aseptic loosening of the stem occurred in four femora, and the femoral component was undersized in all four. These four stems were stable for ten years and then underwent progressive subsidence, which was associated with pain. Five stems were revised because of a late postoperative periprosthetic fracture following trauma. Localized proximal femoral osteolysis was seen in seven hips without signs of loosening. Survivorship of the stem with revision for any reason as the end point was estimated to be 90% (95% confidence interval, 87% to 97%) at twenty years. Survivorship with aseptic loosening as the end point was estimated to be 95% (95% confidence interval, 91% to 99%) at twenty years. Sixty-seven (44%) of the threaded uncemented acetabular components were revised during the follow-up period.

CONCLUSIONS

After a minimum duration of follow-up of fifteen years, the survival of this type of femoral component is excellent in individuals younger than fifty-five years. The main mode of stem failure was a periprosthetic fracture due to trauma, or late aseptic loosening in a small percentage of the hips in which the femoral implant was undersized. The high rate of failure of the acetabular components was attributable to a poor design that is no longer in use.

摘要

背景

无骨水泥全髋关节置换术常用于年轻活跃的患者，但随访超过15年的结局数据有限。

方法

我们回顾性评估了141例年龄小于55岁患者中连续154例采用喷砂处理的直柄锥形非骨水泥钛股骨柄联合螺纹髋臼杯进行的全髋关节置换术的临床和影像学结果。中位随访时间为17年。使用Harris髋关节评分评估临床结果。采用髓腔填充指数作为确定股骨柄尺寸是否合适的标准。进行Kaplan-Meier生存分析以预测长期结局。

结果

41个股骨（27%）的股骨柄尺寸过小，髓腔填充指数≤80%。4个股骨出现股骨柄晚期无菌性松动，且这4个股骨的股骨组件尺寸均过小。这4个股骨柄在10年内保持稳定，随后逐渐下沉，并伴有疼痛。5个股骨柄因创伤后晚期假体周围骨折而翻修。7个股骨出现局限性股骨近端骨溶解，但无松动迹象。以任何原因翻修为终点，股骨柄20年的生存率估计为90%（95%置信区间，87%至97%）。以无菌性松动为终点，20年的生存率估计为95%（95%置信区间，91%至99%）。在随访期间，67个（44%）螺纹非骨水泥髋臼组件进行了翻修。