The McMinn Centre, 25 Highfield Road, Edgbaston, Birmingham, B15 3DP, UK.
Clin Orthop Relat Res. 2011 Jun;469(6):1589-97. doi: 10.1007/s11999-010-1739-0.
High medium-term survivorship of hip resurfacing arthroplasty in young patients has led to its increased usage. To achieve high survival rates, selecting patients with appropriate proximal femoral morphology and bone quality is important. For patients with poor bone quality or abnormal morphology, the mid-head resection technique is an alternative, bone-conserving procedure but whether this technique results in acceptable complications and survival is unknown.
QUESTIONS/PURPOSES: We therefore assessed (1) implant survivorship of a mid-head resection device during short- and medium-term followup, (2) hip function, (3) adverse radiographic features emphasizing proximal stress shielding, and (4) complications.
We retrospectively reviewed 164 patients (171 hips) who underwent reconstruction with the Birmingham Mid-Head Resection device (Smith and Nephew Orthopaedics Ltd, Warwick, UK) between 2003 and 2008. Patients were reviewed with hip outcome questionnaires, clinical examination, and radiographs. We report findings in 156 of these 171 hips with a minimum followup of 2 years (mean, 3.5 years, range, 2-7.5 years). They include three successive iterations based on the same design rationale.
There were four revisions during this period, including two femoral failures, giving 3.5-year survivorships of 97.4% and 98.7% with revision or reoperation for any reason and femoral failure as the end points, respectively. No patient is currently awaiting revision. Average hip function was 98%, as assessed by Oxford hip score. Five of the 87 intermediate-iteration (V1) stems showed proximal femoral stress shielding, a phenomenon not observed in the other two iterations. Four patients had asymptomatic below-knee deep venous thrombosis and one had nonfatal pulmonary embolism, all of which resolved uneventfully.
The mid-head resection technique can circumvent the need for a more invasive procedure such as standard THA in patients who would benefit from a conservative arthroplasty but do not possess good femoral head bone quality or morphology.
髋关节表面置换术在年轻患者中的高中期生存率导致其应用增加。为了获得高生存率，选择具有适当股骨近端形态和骨质量的患者非常重要。对于骨质量差或形态异常的患者，采用中头部切除技术是一种替代的保骨手术，但该技术是否会导致可接受的并发症和生存率尚不清楚。
问题/目的：因此，我们评估了（1）中头部切除装置在短期和中期随访期间的植入物存活率，（2）髋关节功能，（3）强调近端应力遮挡的不良放射学特征，以及（4）并发症。
我们回顾性分析了 2003 年至 2008 年间接受 Birmingham Mid-Head Resection 装置（Smith and Nephew Orthopaedics Ltd，Warwick，UK）重建的 164 例患者（171 髋）。对患者进行髋关节功能问卷、临床检查和 X 线检查。我们报告了其中 171 髋中的 156 髋的结果，随访时间至少为 2 年（平均 3.5 年，范围 2-7.5 年）。这些患者包括基于相同设计原理的三个连续迭代。
在此期间，有 4 例进行了翻修，包括 2 例股骨失败，以任何原因进行翻修或再次手术和股骨失败作为终点，分别得出 3.5 年的存活率为 97.4%和 98.7%。目前没有患者需要翻修。根据牛津髋关节评分，平均髋关节功能为 98%。在 87 个中间迭代（V1）柄中，有 5 个出现了股骨近端应力遮挡现象，而在其他两个迭代中没有观察到这种现象。有 4 例患者出现无症状的膝下深静脉血栓形成，1 例发生非致命性肺栓塞，均无并发症地得到解决。
中头部切除技术可以避免需要更具侵入性的手术，如标准 THA，对于那些需要保守性关节置换但股骨头骨质量或形态不佳的患者，可以采用这种技术。
