Department of Orthopaedics and Trauma, Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, SA 5000, Australia.
Clin Orthop Relat Res. 2012 Nov;470(11):3024-31. doi: 10.1007/s11999-012-2327-2.
Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.
QUESTIONS/PURPOSES: We examined femoral stem survival, bone deficiency at revision arthroplasty, and radiographic bone loss in hips implanted with a cemented polished double-taper stem in a cohort of patients younger than 55 years.
We reviewed 197 hips (median patient age, 47 years; range, 16-54 years) after a minimum followup of 2 years (median, 7 years; range, 2-19 years) since primary THA. Clinically, we determined survival to major and minor stem revision and cases of bone deficiency requiring a long stem or impaction bone grafting or created by the need for femoral osteotomy at revision arthroplasty. Radiographically, we assessed stem loosening, femoral osteolysis, and femoral bone deficiency.
Stem survival to major revision for aseptic loosening was 100% at 13 years and for any reason was 97% (95% CI, 93-100%). At revision of seven stems, a long stem was used in one hip, a total femoral replacement in one hip and impaction bone grafting in one hip. No femoral osteotomies were required. Bone was preserved in four hips by cement-within-cement stem exchange. No stems were radiographically loose. Proximal osteolysis was present in 11% of femurs. Femoral bone deficiency was graded as Paprosky Type I (97%) or II (3%) and Endo-Klinik Grade 0 (79%) or I (21%).
Cemented polished taper stems have high survival at 13 years in young patients and enable femoral bone preservation for subsequent revision.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
在初次全髋关节置换术 (THA) 后，确保股骨骨保存的技术对于可能需要接受翻修手术的年轻患者非常重要。
问题/目的：我们检查了在年龄小于 55 岁的患者中，使用骨水泥抛光双锥形股骨柄植入的髋关节中股骨柄的存活率、翻修时的骨缺损以及影像学的骨丢失。
我们回顾了 197 髋（中位患者年龄，47 岁；范围，16-54 岁），自初次 THA 后至少随访 2 年（中位，7 年；范围，2-19 年）。临床方面，我们确定了主要和次要的柄翻修的生存率，以及需要长柄或打压植骨或因翻修时需要股骨截骨而导致的骨缺损病例。影像学方面，我们评估了柄松动、股骨溶骨和股骨骨缺损。
在 13 年时，因无菌性松动导致的主要翻修的柄存活率为 100%，因任何原因导致的存活率为 97%（95%CI，93-100%）。在 7 例翻修中，1 例使用了长柄，1 例使用了全股骨置换和打压植骨，1 例需要股骨截骨。没有需要进行股骨截骨的病例。通过骨水泥内骨水泥柄交换，4 例髋关节保留了骨量。没有出现影像学上的松动。近端骨溶解见于 11%的股骨。股骨骨缺损分级为 Paprosky Ⅰ型（97%）或Ⅱ型（3%）和 Endo-Klinik 分级 0 级（79%）或Ⅰ级（21%）。
在年轻患者中，骨水泥抛光锥形股骨柄在 13 年时具有高存活率，并能够为随后的翻修保留股骨骨量。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
