Department of Orthopaedic Surgery, Inselspital, University of Bern, Murtenstrasse, 3010 Bern, Switzerland.
Arch Orthop Trauma Surg. 2009 Dec;129(12):1691-1700. doi: 10.1007/s00402-009-0977-7.
The purpose of this study was to prospectively evaluate the 5-13-year results of a cementless total hip arthroplasty with a special focus on the survivorship,occurrence of osteolysis, incidence of intraoperative femoral fractures, thigh pain, and cortical hypertrophy of the femoral stem. The femoral component used in this study was titanium fluted, slotted, symmetrical component that was prepared with intraoperative machining. The proximal third of the stem had hydroxyl-apatite coating and horizontal steps.
The clinical and radiographical results of a consecutive series of 157 total hip arthroplasties (124 patients)with this stem were investigated. Minimum follow-up was 5 years. The average age of the patients at the time of surgery was 47 years. Three patients died and ten patients were lost to follow-up, leaving 142 hips for evaluation. The clinical result was evaluated on the basis of the Merled’Aubigné score, complications and thigh pain. A detailed radiographic analysis was performed at each follow-up visit. Kaplan–Meier survivorship analysis was performed to evaluate stem, cup, and bearing survivorship.
The mean follow-up was 8.5 years (range 5-13 years). The average Merle d’Aubigné score improved from 10.5 points preoperatively to 17.4 points postoperatively.The cumulative 10-year survival rate was 99% for the femoral component, 99% for the acetabular component,and 69% for the bearing. Thigh pain was identified in three patients (2%). There was no distal femoral osteolysis.Seventy-nine percent of all the hips had endosteal spot welds around the coated, proximal one-third of the prosthesis.51% had radio dense lines around the distal tip of the prosthesis,and 3% had cortical hypertrophy. One undersized stem and one cup were revised for aseptic loosening, and 25 bearings were exchanged.
Uncemented, machined, fluted titanium canal-filling femoral components achieve reliable fixation in this young patient population. They have a decreased incidence of activity-related thigh pain, lower rate of intraoperative femur fractures and cortical hypertrophy with comparable bone-ingrowth in comparison to other second generation uncemented femoral components described in literature. Bearing wear and the need for bearing exchange was the only limitation of these constructs.
本研究的目的是前瞻性评估一种非骨水泥全髋关节置换术的 5-13 年结果，特别关注假体存活率、骨溶解的发生、术中股骨骨折的发生率、大腿疼痛以及股骨柄的皮质骨增生。本研究中使用的股骨部件为钛制带槽、带槽、对称部件，采用术中机械加工制备。柄的近端三分之一有羟基磷灰石涂层和水平台阶。
对连续 157 例（124 例患者）采用该柄的全髋关节置换术的临床和影像学结果进行了调查。最低随访时间为 5 年。手术时患者的平均年龄为 47 岁。3 例患者死亡，10 例患者失访，142 髋接受评估。临床结果基于 Merled’Aubigné 评分、并发症和大腿疼痛进行评估。每次随访时均进行详细的影像学分析。采用 Kaplan-Meier 生存分析评估柄、杯和轴承的生存率。
平均随访时间为 8.5 年（5-13 年）。平均 Merle d’Aubigné 评分从术前的 10.5 分提高到术后的 17.4 分。股骨部件的 10 年累积存活率为 99%，髋臼部件为 99%，轴承为 69%。3 例（2%）患者出现大腿疼痛。无远端股骨骨溶解。所有髋关节中，79%有涂层近端三分之一的假体周围有骨内点焊，51%有假体远端尖端周围有放射性致密线，3%有皮质骨增生。1 个尺寸过小的柄和 1 个杯因无菌性松动而被修正，25 个轴承被更换。
在年轻患者人群中，非骨水泥、机械加工、带槽钛制填充骨通道的股骨部件可实现可靠固定。与文献中描述的其他第二代非骨水泥股骨部件相比，它们具有较低的活动相关大腿疼痛发生率、术中股骨骨折发生率和皮质骨增生率，同时具有类似的骨长入。轴承磨损和需要更换轴承是这些结构的唯一局限性。
