Division of Orthopaedic Surgery, McGill University, 1650 Cedar Avenue #B5159, Montreal, QC H3G 1A4, Canada.
Clin Orthop Relat Res. 2011 Feb;469(2):508-13. doi: 10.1007/s11999-010-1524-0.
A femoral implant with a modular sleeve and stem has been designed to allow independent and complete metaphyseal-diaphyseal fit and fill as well as independent rotation to accommodate anteversion at the time of THA.
QUESTIONS/PURPOSES: In a prospective study we asked whether such a modular femoral sleeve and stem implant used during THA could provide (1) high long-term survivorship; (2) radiographically stable implants without radiolucencies, stress shielding, or osteolysis; and (3) high clinical scores in patients 15 to 20 years after a primary THA.
We prospectively evaluated 31 hips that underwent a primary THA using a modular femoral component for clinical outcome (Harris hip score) and radiographic outcome (implant stability, femoral loosening, osteolysis and stress shielding) at a minimum followup of 15 years (mean, 17 years; range, 15-20.2 years).
There were no femoral revisions for aseptic loosening; all hips had radiographic evidence of bone ingrowth. Two well-ingrown components were revised for late hematogenous infection. Some degree of proximal femoral disuse atrophy from stress shielding occurred in 23 hips (74%) but was nonprogressive and did not result in any failures or complications. Femoral osteolysis occurred in 18 hips (58%), but we cannot definitively determine whether or not the modular junction contributed to this.
These data suggest this modular femoral stem can provide long-term survivorship with no cases of aseptic loosening at 15 to 20 years after primary THA. However, it may be prudent when using this femoral stem to consider an articulation with an alternative bearing or, if the modularity is not needed to address femoral anteversion and metaphyseal-diaphyseal mismatch, to consider a nonmodular femoral stem.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
一种带有模块化套筒和柄的股骨假体设计用于实现独立和完全的干骺端-骨干匹配和填充，以及独立旋转，以适应全髋关节置换术时的前倾角。
问题/目的：在一项前瞻性研究中，我们询问在全髋关节置换术中使用这种模块化股骨套筒和柄植入物是否可以提供（1）高的长期存活率；（2）无透亮线、应力遮挡或骨溶解的影像学稳定植入物；以及（3）初次全髋关节置换后 15 至 20 年患者的高临床评分。
我们前瞻性评估了 31 例接受了初次全髋关节置换术的患者，使用模块化股骨组件进行临床结果（Harris 髋关节评分）和影像学结果（植入物稳定性、股骨松动、骨溶解和应力遮挡）评估，随访时间至少为 15 年（平均 17 年；范围，15-20.2 年）。
无股骨翻修因无菌性松动；所有髋关节均有骨长入的影像学证据。两个愈合良好的组件因晚期血源性感染而被翻修。23 髋（74%）存在一定程度的近端股骨废用性萎缩，但无进行性进展，且未导致任何失败或并发症。18 髋（58%）发生股骨骨溶解，但我们不能确定是否是模块化连接导致了这种情况。
这些数据表明，这种模块化股骨柄在初次全髋关节置换后 15 至 20 年可提供长期存活率，无无菌性松动病例。然而，在使用这种股骨柄时，谨慎起见，可以考虑与替代关节面的关节，或者如果不需要模块化来解决股骨前倾角和干骺端-骨干不匹配，可以考虑使用非模块化股骨柄。
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
