Department of Orthopaedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho, Midori-ku, Chiba, Japan.
Mod Rheumatol. 2011 Oct;21(5):482-7. doi: 10.1007/s10165-011-0431-x. Epub 2011 Mar 5.
Twenty cementless total hip revision arthroplasties using Anatomic BR stems were performed in 20 patients. Fourteen patients, with a mean age of 62.6 years (range 41-74 years) at time of revision surgery, were followed retrospectively for a minimum of 10 years (range 11-15 years). Clinical function and radiographic evidence of implant stability were evaluated. Preoperative femoral deficiencies were evaluated radiographically and classified according to Paprosky type as follows: four Type-II, four Type-IIIA, four Type-IIIB, and two Type-IV femurs. Mean preoperative Harris hip score was 46.3 points (range 29-58 points) and improved to 68.8 points (range 45-90 points) at the most recent follow-up examination. Of the 14 patients followed, six had radiographic evidence of subsidence (axial shift of more than 2 mm after revision with long-stem components). Component fixation showed bone ingrowth in three (21%) patients, inconclusive evidence of ingrowth in six (43%) patients, suboptimal but stable fixation in three (21%) patients, and unstable fixation in two (14%) patients. Based on these we results, we conclude that even with circumferential proximal porous coating and improved proximal geometry, nonmodular femoral implant stability remains unpredictable following total hip arthroplasty revision.
20 例采用 Anatomic BR 柄的非骨水泥全髋关节翻修术在 20 例患者中进行。14 例患者，翻修手术时的平均年龄为 62.6 岁（41-74 岁），最少随访 10 年（11-15 年）。评估了临床功能和影像学证据的植入物稳定性。术前股骨缺损通过影像学评估，并根据 Paprosky 类型分类如下：4 例Ⅱ型，4 例ⅡIA 型，4 例ⅡIB 型，2 例Ⅳ型股骨。术前 Harris 髋关节评分平均为 46.3 分（29-58 分），最近随访时提高至 68.8 分（45-90 分）。14 例随访患者中，6 例有影像学下沉证据（翻修后长柄组件轴向移位超过 2mm）。3 例（21%）患者的组件固定显示骨长入，6 例（43%）患者的骨长入证据不确定，3 例（21%）患者的固定效果不理想但稳定，2 例（14%）患者的固定不稳定。根据这些结果，我们得出结论，即使采用环形近端多孔涂层和改进的近端几何形状，非模块化股骨植入物的稳定性在全髋关节翻修后仍然难以预测。
