Wykman A, Olsson E, Axdorph G, Goldie I
Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
J Arthroplasty. 1991 Mar;6(1):19-29. doi: 10.1016/s0883-5403(06)80153-1.
This study compares cemented (Charnley) with noncemented (Honart Patel-Garches) total hip arthroplasty. 150 patients with osteoarthritis, rheumatoid arthritis, and miscellaneous conditions were randomized into either group with 75 in each. Patients were evaluated over 5 postoperative years with examinations at 6 months, at 1 year, and then annually. Each examination involved clinical assessment, objective gait analysis, and radiographic examination. The Charnley group improved faster than the HP-Garches group during the first 2 years. At the last evaluation the results were excellent or good in 79% in the Charnley group and 70% in the HP-Garches group. In the HP-Garches group midthigh pain occurred in 64%. Five patients with Charnley prostheses (6.7%) and 14 patients with HP-Garches prostheses (18.7% had revision surgery to correct mechanical loosening. Standard radiography revealed radiolucent zones in both groups, but this could not be related to the clinical outcome despite radiolucency being present in all noncemented replacements on the femoral side. Objective gait analysis confirmed inferior clinical results at 6 months in the HP-Garches group. There was no significant difference between the groups at the most recent evaluation. Our findings are not consistent with earlier optimistic expectations on press-fit noncemented total hip arthroplasties.
本研究比较了骨水泥型（Charnley）与非骨水泥型（Honart Patel - Garches）全髋关节置换术。150例骨关节炎、类风湿关节炎及其他病症患者被随机分为两组，每组75例。术后5年对患者进行评估，分别在术后6个月、1年，之后每年进行检查。每次检查包括临床评估、客观步态分析和影像学检查。Charnley组在前两年的改善速度比HP - Garches组快。在最后一次评估时，Charnley组79%的结果为优或良，HP - Garches组为70%。在HP - Garches组中，64%的患者出现大腿中部疼痛。5例使用Charnley假体的患者（6.7%）和14例使用HP - Garches假体的患者（18.7%）进行了翻修手术以纠正机械性松动。标准X线摄影显示两组均有透亮区，但尽管所有股骨侧非骨水泥型置换均存在透亮区，这与临床结果并无关联。客观步态分析证实HP - Garches组在术后6个月临床结果较差。在最近一次评估时，两组之间无显著差异。我们的研究结果与早期对压配式非骨水泥型全髋关节置换术的乐观预期不一致。
