Snorrason F, Kärrholm J
Department of Orthopedics, University Hospital, Umeå, Sweden.
J Arthroplasty. 1990 Sep;5(3):217-29. doi: 10.1016/s0883-5403(08)80076-9.
The primary migration of 15 and 22 cemented acetabular and femoral prosthetic components was recorded in 23 patients operated because of type I (minimal endosteal bone loss) and type II (thinning of bone, enlargement of femoral canal and acetabulum) mechanical loosening. Roentgen stereophotogrammetric analysis was used to measure the three-dimensional displacements of the center of the acetabulum and the femoral head. All but 1 of the acetabular and 1 of 15 revised femoral stem prostheses migrated within 2 years after the operation, whereas 5 of 7 revised femoral surface arthroplasties were stable. Femoral components with type II loosening migrated, on average, 1.5 mm (range, 0.6-3.0 mm) during the first postoperative year, compared with 0.7 mm (range, 0.3-1.1 mm) in patients with type I loosening (P less than .02). Increased bone loss of the acetabulum (type II), the quality of the bone-cement interface as judged from radiographs, and the presence of perforation of the femoral cortex did not significantly influence the rate of migration in this group. Compared with previously presented studies of cemented primary hip prostheses, cemented revisions seem not only to migrate more frequently but also at a higher rate. Poor primary fixation is probably one important cause of the high frequency of clinical failures in these patients.
对23例因I型（最小骨内膜骨丢失）和II型（骨质变薄、股骨髓腔及髋臼扩大）机械性松动而接受手术的患者，记录了15个和22个骨水泥固定髋臼及股骨假体组件的初次移位情况。采用X线立体摄影测量分析来测定髋臼中心和股骨头的三维位移。除1个髋臼假体和15个翻修股骨柄假体中的1个外，其余所有假体均在术后2年内发生移位，而7个翻修股骨表面置换术中5个保持稳定。II型松动的股骨组件在术后第1年平均移位1.5mm（范围0.6 - 3.0mm），而I型松动患者为0.7mm（范围0.3 - 1.1mm）（P < 0.02）。髋臼骨丢失增加（II型）、根据X线片判断的骨水泥界面质量以及股骨皮质穿孔的存在，对该组患者的移位率无显著影响。与先前发表的关于骨水泥固定初次髋关节假体的研究相比，骨水泥翻修假体似乎不仅移位更频繁，而且移位速率更高。初次固定不佳可能是这些患者临床失败率高的一个重要原因。
