Orthopaedic Surgery and Traumatology Department, Bordeaux Teaching Hospital Center, Bordeaux, France. bardou jacquet
Orthop Traumatol Surg Res. 2009 Jun;95(4):243-8. doi: 10.1016/j.otsr.2009.04.007. Epub 2009 Jun 11.
Primary revisions using cement without bone graft reconstruction are less frequently used because of their supposed higher failure rate. The results, in fact, depend on multiple parameters: number of prior revisions, cementing technique quality, and residual bone stock; these intricate factors are rarely taken together into account when analyzing this treatment method.
Femoral component fixation with cement can be a valid option in total hip arthroplasty primary revision.
The objective of this investigation was to study the long-term results of cemented femoral stems in total hip arthroplasty primary revisions in terms of the quality of the cementing technique and the residual bone stock.
This is a retrospective study of a series of 80-cemented primary femoral stems revised for aseptic loosening using a new-cemented femoral stem without bone graft. Seventy implants were analyzed at the longest follow-up. The Postel Merle D'Aubigné and the Harris Hip Scores were used for clinical assessment. The French Academy SOFCOT 99 bone loss grading system was used to classify preoperative bone compromise severity. The Barrack classification assessed the quality of the postoperative cementation. The radiographic study at the last follow-up sought signs of femoral implant loosening classified according to Harris.
The mean follow-up was 10 years and 10 months. The functional evaluation of the hip showed a significant overall gain (p<0.0001) after surgical revision. In our series, the existence of severe grade III or IV bone loss on the SOFCOT 99 classification exposed the patient to a significant risk of intraoperative complications (p=0.03). The grade III and IV femurs had a significantly higher risk (p=0.0001) of having type C or D cementation according to the Barrack classification. Type D cementation was a risk factor for significant iterative radiographic loosening (p=0.005) compared to A, B or C cementations. The 10-year survival rate of the femoral implant was 90% (95% confidence interval [95% CI]: 79.2-94.9%). This survival rate was significantly better (p=0.0016) for revisions with type A or B cementations on the Barrack scale (96% survival; 95% CI: 85.1-99%) than for type C or D (70% survival; 95% CI: 41.4-86.1%).
This study shows that revised cemented femoral stems without bone graft added are a valid therapeutic option in primary cemented total hip arthroplasty revisions provided that a good-quality cement technique can be achieved. Sufficient bone stock (SOFCOT 99 grade 0, I or II) was indispensable for good cementation.
IV: therapeutic retrospective study.
由于其较高的失败率，不使用骨移植进行初次翻修的水泥固定术较少被采用。然而，事实上，其结果取决于多个参数：初次翻修的次数、骨水泥技术质量和残余骨量；在分析这种治疗方法时，很少综合考虑这些复杂的因素。
在全髋关节初次翻修中，使用骨水泥固定股骨部件是一种有效的选择。
本研究旨在探讨在不进行骨移植的情况下，使用新的骨水泥固定股骨柄对初次翻修的全髋关节置换术进行骨水泥固定技术质量和残余骨量的长期结果。
这是一项回顾性研究，纳入了 80 例因无菌性松动而接受初次翻修的使用新型骨水泥固定股骨柄的患者。最长随访时分析了 70 例植入物。临床评估采用 Postel Merle D'Aubigné 和 Harris 髋关节评分。采用法国 SOFCOT 99 骨丢失分级系统对术前骨缺损严重程度进行分类。Barrack 分类评估术后骨水泥固定的质量。在末次随访时进行放射学研究，根据 Harris 分类评估股骨植入物松动的迹象。
平均随访时间为 10 年 10 个月。髋关节功能评估显示，术后翻修后整体功能显著改善（p<0.0001）。在我们的研究中，SOFCOT 99 分级中严重的 III 级或 IV 级骨丢失使患者面临术中并发症的显著风险（p=0.03）。III 级和 IV 级股骨发生 C 或 D 型骨水泥固定的风险显著更高（p=0.0001）。根据 Barrack 分类，C 或 D 型骨水泥固定为显著迭代放射学松动的危险因素（p=0.005）。与 A、B 或 C 型骨水泥固定相比，D 型骨水泥固定的股骨植入物 10 年生存率为 90%（95%置信区间 [95%CI]：79.2-94.9%）。在 Barrack 分级中，A 或 B 型骨水泥固定的翻修生存率显著更好（p=0.0016），为 96%（95%CI：85.1-99%），而 C 或 D 型为 70%（95%CI：41.4-86.1%）。
本研究表明，在初次全髋关节初次骨水泥固定翻修中，不进行骨移植添加的翻修水泥固定股骨柄是一种有效的治疗选择，前提是可以达到高质量的骨水泥技术。足够的骨量（SOFCOT 99 分级 0、I 或 II）对于良好的骨水泥固定是必不可少的。
IV 级：治疗性回顾性研究。
