非骨水泥锥形钛合金股骨部件的长期（20-25 年）结果和影响生存率的因素。
Long-term (20- to 25-year) results of an uncemented tapered titanium femoral component and factors affecting survivorship.
机构信息
Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
出版信息
Clin Orthop Relat Res. 2013 Oct;471(10):3262-9. doi: 10.1007/s11999-013-3033-4. Epub 2013 May 14.
BACKGROUND
Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade.
QUESTIONS/PURPOSES: We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.
METHODS
We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed.
RESULTS
Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index≤80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets.
CONCLUSIONS
Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
在初次全髋关节置换术（THA）中，非骨水泥股骨假体已广泛应用，但很少有研究评估其在第三个十年的生存率。
问题/目的：我们评估了（1）以任何原因进行股骨翻修为终点的生存率；（2）以无菌性松动进行股骨翻修为终点的生存率；（3）在至少 20 年的随访中，使用非骨水泥锥形钛合金股骨柄，与无菌性柄松动相关的患者相关和手术风险因素。
方法
我们回顾了 1985 年 1 月至 1989 年 12 月期间使用非骨水泥喷砂、锥形钛合金股骨柄进行的 354 例 THA 的临床和影像学结果，共 326 例患者。手术时的平均年龄为 57 岁（范围 13-81 岁）。采用 Kaplan-Meier 生存分析估计长期生存率。最低随访评估为 20 年（平均 22 年；范围 20-25 年）；此时，120 例患者（127 髋）死亡，4 例患者（5 髋）失访。采用 Cox 回归模型进行多变量生存分析。
结果
以任何原因进行股骨翻修为终点的 22 年生存率为 86%（95%置信区间[CI]，81%-90%）。以无菌性松动进行股骨翻修为终点的 22 年生存率为 93%（95%CI，90%-96%）。小号柄（管腔填充指数≤80%）和髋臼杯翻修的髋关节中的柄与无菌性松动的风险较高（危险比分别为 4.2 和 4.3）。该系列中髋臼翻修率较高（38%），主要与光滑螺纹、非骨水泥髋臼有关。
结论
非骨水泥股骨固定在第三个十年是可靠的。年龄、性别和诊断与无菌性松动的风险增加无关。
证据水平
IV 级，治疗研究。有关证据水平的完整描述，请参阅作者指南。
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