Sanz-Reig Javier, Lizaur-Utrilla Alejandro, Llamas-Merino Isabel, Lopez-Prats Fernando
Department of Orthopaedic Surgery, Elda General Hospital, Faculty of Medicine, Miguel Hernandez University, Elche, Spain.
J Orthop Surg (Hong Kong). 2011 Aug;19(2):169-73. doi: 10.1177/230949901101900207.
To evaluate long-term outcomes of total hip arthroplasty (THA) using the Perfecta cementless system.
73 men and 76 women aged 65 to 88 (mean, 71) years underwent 168 THAs using the Perfecta cementless system and were followed up for a mean of 13 (10 to 15) years. 19 patients had bilateral THA. The diagnoses were idiopathic osteoarthritis (n=121), osteonecrosis of the femoral head (n=25), rheumatoid arthritis (n=14), and post-traumatic osteoarthritis (n=8). Patients were evaluated clinically and radiographically before and after THA.
The mean Harris hip score improved from 40 to 84 (p<0.001); the score was excellent or good in 130 hips, fair in 17, and poor in 21. The mean Merle D'Aubigne score improved from 4 to 10 (p<0.001); the score was excellent or good in 138 hips, fair in 9, and poor in 21. Poor results were due to aseptic revision of the cup (n=16) or stem (n=3) or deep infection (n=2). Thigh pain that limited activities of daily living was noted in 3 hips. 142 patients could walk without a limp, 5 had a slight limp, and 3 had a moderate limp and used a cane. The mean Short Form-12 score for the physical function was 49 and for the mental health was 56; the mean Western Ontario and McMaster Universities Osteoarthritis Index was 39; the mean visual analogue scale score for satisfaction was 8. Two patients developed deep infection at postoperative months 8 and 50 and were treated with 2-staged revision. Five patients had hip dislocation within 2 months; 3 of whom endured recurrent dislocation and underwent revision surgery; they had acetabular malposition with excessive anteversion despite a correct acetabular angle. 13 other cups were revised because of loosening or extensive osteolysis (n=10) and polyethylene wear (n=3) after a mean interval of 6 (range, 4-10) years. Three stems were revised because of aseptic loosening after a mean interval of 7 (range, 6-9) years. The survivorship at 14 years was 99% for stems and 91% for cups.
The long-term outcome of the Perfecta cementless stem was good; most major complications occurred in the cup.
评估使用Perfecta非骨水泥系统进行全髋关节置换术（THA）的长期疗效。
73名男性和76名女性，年龄65至88岁（平均71岁），使用Perfecta非骨水泥系统接受了168例THA手术，并进行了平均13年（10至15年）的随访。19例患者接受了双侧THA。诊断包括特发性骨关节炎（n = 121）、股骨头坏死（n = 25）、类风湿性关节炎（n = 14）和创伤后骨关节炎（n = 8）。在THA前后对患者进行临床和影像学评估。
Harris髋关节平均评分从40分提高到84分（p < 0.001）；130个股关节评分优秀或良好，17个股关节评分中等，21个股关节评分差。Merle D'Aubigne平均评分从4分提高到10分（p < 0.001）；138个股关节评分优秀或良好，9个股关节评分中等，21个股关节评分差。疗效不佳的原因是髋臼（n = 16）或股骨柄（n = 3）的无菌性翻修或深部感染（n = 2）。3个股关节出现限制日常生活活动的大腿疼痛。142例患者能够行走无跛行，5例有轻微跛行，3例有中度跛行并使用手杖。简明健康调查量表（Short Form-12）身体功能平均评分为49分，心理健康平均评分为56分；西安大略和麦克马斯特大学骨关节炎指数（Western Ontario and McMaster Universities Osteoarthritis Index）平均为39分；满意度视觉模拟量表（visual analogue scale）平均评分为8分。2例患者分别在术后第8个月和第50个月发生深部感染，并接受了二期翻修治疗。5例患者在2个月内发生髋关节脱位；其中3例反复脱位并接受了翻修手术；尽管髋臼角度正确，但他们存在髋臼位置不良伴过度前倾。另外13个髋臼因松动或广泛骨溶解（n = 10）以及聚乙烯磨损（n = 3）在平均6年（范围4 - 10年）后进行了翻修。3个股骨柄因无菌性松动在平均7年（范围6 - 9年）后进行了翻修。股骨柄14年生存率为99%，髋臼为91%。
Perfecta非骨水泥股骨柄的长期疗效良好；大多数主要并发症发生在髋臼。
