Department of Orthopaedic Surgery, Center for Arthritis Surgery, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France.
Clin Orthop Relat Res. 2010 Mar;468(3):747-55. doi: 10.1007/s11999-009-1045-x. Epub 2009 Aug 19.
THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
对于年轻患者而言，THA 具有挑战性，这是因为患者年轻、活跃，且往往存在解剖结构紊乱的问题。我们想知道，三维定制非骨水泥假体能否恢复髋关节功能、减少骨溶解和磨损、提高年轻患者的假体生存率。我们回顾性分析了 212 例（233 髋）年龄小于 50 岁（平均年龄 40 岁）的患者，随访时间为 5 至 16 年（平均 10 年）。末次随访时，Merle D'Aubigné-Postel 和 Harris 髋关节评分均得到改善。所有患者均无大腿疼痛；212 例患者中有 187 例（88%）完全恢复了活动能力，206 例恢复了全范围活动度，151 例 Hip disability and Osteoarthritis Outcome 评分的所有 5 个项目得分均大于 80 分。5 例患者出现股骨骨溶解，但无疼痛。以任何原因翻修为终点，15 年时的生存率为 87%（范围为 77%-97%），仅考虑翻修假体，15 年时的生存率为 93%（置信区间为 90%-97%）。与使用标准非骨水泥假体的同随访时间系列研究相比，我们的数据具有可比性，这些研究中大多数患者实现了功能恢复，且并发症发生率较低。
IV 级，治疗性研究。欲了解完整的证据水平描述，请参见《作者指南》。
