Department of Orthopaedic Surgery, University of Heidelberg, Germany.
Acta Orthop. 2010 Feb;81(1):126-33. doi: 10.3109/17453671003587077.
Variations in hip anatomy limit the femoral canal fit of standard uncemented hip stems. In addition, there are still issues with leg length discrepancy and offset reconstruction, potentially resulting in impingement, dislocation, and wear. Modular stems with different shapes for femoral canal fit and multiple neck options may improve the outcome and reduce complications.
173 patients (190 hips) received an uncemented THA with 1 of 2 different stem shapes for canal fit and a modular neck for stature-specific hip reconstruction. Median follow-up time was 9 (7-13) years. During the follow-up period, 20 patients died (22 hips) and 12 patients (13 hips) were lost to follow-up. 155 hips were available for evaluation, including clinical and radiological outcome.
1 stem was revised for a periprosthetic fracture following trauma; 10 cups and 2 modular necks were revised (1 for breakage and 1 during cup revision). At 10 years, stem survival was 100%, modular neck survival was 99% (CI: 95-100), and cup survival was 94% (CI: 87-97). No leg length discrepancies were measured in 96% of cases. Offset with anatomic lateralization was achieved in 98%. Median Harris hip score was 94 (47-100) and median Merle d'Aubigné score was 16 (10-18). Relevant radiolucent lines and osteolysis were not found.
The uncemented modular neck, dual-stem system used in this series allows accurate reconstruction of the joint by adapting the implant to the needs of the patient. This may improve the outcome of primary THA, which is supported by the results of this medium-term follow-up evaluation.
髋部解剖结构的差异限制了标准非骨水泥髋关节假体柄在股骨通道中的匹配度。此外，下肢长度差异和偏心距重建仍然存在问题，可能导致撞击、脱位和磨损。具有不同股骨通道匹配形状和多种颈选择的模块化假体可能会改善结果并减少并发症。
173 例（190 髋）接受了非骨水泥全髋关节置换术，使用 2 种不同形状的假体柄以适应股骨通道，并使用模块化颈进行特定身高的髋关节重建。中位随访时间为 9 年（7-13 年）。随访期间，20 例患者死亡（22 髋），12 例患者失访（13 髋）。155 髋可进行评估，包括临床和影像学结果。
1 例因创伤导致假体周围骨折而翻修；10 个髋臼杯和 2 个模块化颈需要翻修（1 例因断裂，1 例在髋臼杯翻修时）。10 年时，假体柄存活率为 100%，模块化颈存活率为 99%（CI：95-100），髋臼杯存活率为 94%（CI：87-97）。96%的病例未测量到下肢长度差异。98%的病例达到了解剖侧方的偏心距。中位数 Harris 髋关节评分为 94 分（47-100），Merle d'Aubigné 评分为 16 分（10-18）。未发现相关的透亮线和骨溶解。
本研究系列中使用的非骨水泥模块化颈、双假体柄系统允许通过使植入物适应患者的需求来精确重建关节。这可能会改善初次全髋关节置换术的效果，这一结果得到了中期随访评估的支持。
