Department of Orthopedic Surgery, The Ohio State University, Columbus, OH, USA.
J Orthop Surg Res. 2009 Dec 9;4:42. doi: 10.1186/1749-799X-4-42.
As longevity of cementless femoral components enters the third decade, concerns arise with long-term effects of fixation mode on femoral bone morphology. We examined the long-term consequences on femoral remodeling following total hip arthroplasty with a porous plasma-sprayed tapered titanium stem.
Clinical data and radiographs were reviewed from a single center for 97 randomly selected cases implanted with the Mallory-Head Porous femoral component during primary total hip arthroplasty. Measurements were taken from preoperative and long-term follow-up radiographs averaging 14 years postoperative. Average changes in the proximal, middle and diaphyseal zones were determined.
On anteroposterior radiographs, the proximal cortical thickness was unchanged medially and the lateral zone increased 1.3%. Middle cortical thickness increased 4.3% medially and 1.2% laterally. Distal cortical thickness increased 9.6% medially and 1.9% laterally. Using the anteroposterior radiographs, canal fill at 100 mm did not correlate with bony changes at any level (Spearman's rank correlation coefficient of -0.18, 0.05, and 0.00; p value = 0.09, 0.67, 0.97). On lateral radiographs, the proximal cortical thickness increased 1.5% medially and 0.98% laterally. Middle cortical thickness increased 2.4% medially and 1.3% laterally. Distal cortical thickness increased 3.5% medially and 2.1% laterally. From lateral radiographs, canal fill at 100 mm correlated with bony hypertrophy at the proximal, mid-level, and distal femur (Spearman's rank correlation coefficient of 0.85, 0.33, and 0.28, respectively; p value = 0.001, 0.016, and 0.01, respectively).
Stress shielding is minimized with the Mallory-Head titanium tapered femoral stem with circumferential proximal plasma-sprayed coating in well-fixed and well-functioning total hip arthroplasty. Additionally, the majority of femora demonstrated increased cortical thickness in all zones around the stem prosthesis.
Therapeutic Level III.
随着非骨水泥股骨假体的使用寿命进入第三个十年，人们开始关注固定方式对股骨形态的长期影响。我们研究了在初次全髋关节置换中使用多孔等离子喷涂锥形钛股骨柄后对股骨重塑的长期影响。
我们对单中心的 97 例随机选择的 Mallory-Head 多孔股骨组件植入患者的临床数据和 X 线片进行了回顾性研究，这些患者均行初次全髋关节置换术。术后平均随访 14 年，测量术前和长期随访 X 线片上的测量值。确定近端、中间和骨干区的平均变化。
在前后位 X 线片上，内侧皮质厚度无变化，外侧皮质厚度增加 1.3%。中间皮质厚度增加 4.3%（内侧）和 1.2%（外侧）。骨干皮质厚度增加 9.6%（内侧）和 1.9%（外侧）。使用前后位 X 线片，100mm 处的管腔填充与任何水平的骨变化均无相关性（Spearman 秩相关系数为-0.18、0.05 和 0.00；p 值分别为 0.09、0.67 和 0.97）。在侧位 X 线片上，内侧皮质厚度增加 1.5%，外侧增加 0.98%。中间皮质厚度增加 2.4%（内侧）和 1.3%（外侧）。骨干皮质厚度增加 3.5%（内侧）和 2.1%（外侧）。从侧位 X 线片上可以看出，100mm 处的管腔填充与近端、中水平和股骨远端的骨质肥大呈正相关（Spearman 秩相关系数分别为 0.85、0.33 和 0.28；p 值分别为 0.001、0.016 和 0.01）。
在固定良好、功能正常的全髋关节置换术中，Mallory-Head 钛制锥形股骨柄与环形近端等离子喷涂涂层相结合，可最大限度地减少应力屏蔽。此外，大多数股骨在假体周围的所有区域均表现出皮质厚度增加。
治疗水平 III。
